Associations of Multimodal Analgesia With Postoperative Pain Trajectories and Morphine Consumption After Hepatic Cancer Surgery.

Chia-Yi Yeh,Ying-Hsuan Tai,Gar-Yang Chau,Wen-Kuei Chang,Kuang-Yi Chang,Hsiang-Ling Wu

doi:10.3389/fmed.2021.777369

Abstract

BackgroundThis study aimed to investigate the influential factors of postoperative pain trajectories and morphine consumption after hepatic cancer surgery with a particular interest in multimodal analgesia.MethodsPatients receiving hepatic cancer surgery at a tertiary medical center were enrolled between 2011 and 2016. Postoperative pain scores and potentially influential factors like patient characteristics and the analgesic used were collected. Latent curve analysis was conducted to investigate predictors of postoperative pain trajectories and a linear regression model was used to explore factors associated with postoperative morphine consumption.Results450 patients were collected, the daily pain scores during the first postoperative week ranged from 2.0 to 3.0 on average. Male and higher body weight were associated with more morphine consumption (both P < 0.001) but reduced morphine demand was noted in the elderly (P < 0.001) and standing acetaminophen users (P = 0.003). Longer anesthesia time was associated with higher baseline pain levels (P < 0.001). In contrast, male gender (P < 0.001) and standing non-steroidal anti-inflammatory drugs (NSAIDs) use (P = 0.012) were associated with faster pain resolution over time.ConclusionsMultimodal analgesia with standing acetaminophen and NSAIDs had benefits of opioid-sparing and faster pain resolution, respectively, to patients receiving hepatic cancer surgery.

Highlights

Hepatocellular carcinoma (HCC), the most frequent primary liver cancer, often derives from chronic liver disease [1]
Multimodal analgesia is the concept of combining different analgesic modalities that work through different mechanisms of action to achieve better pain relief while reducing opioid consumption as well as drug-related adverse effects [6,7,8]
The mean pain scores were 3.0, 3.6, and 2.8 for patients using pure intravenous patient-controlled analgesia (IVPCA), IVPCA combined with non-steroidal anti-inflammatory drugs (NSAIDs), and IVPCA combined with acetaminophen on the postoperative day (POD) 1, respectively

Summary

Introduction

Hepatocellular carcinoma (HCC), the most frequent primary liver cancer, often derives from chronic liver disease [1]. Multimodal analgesia is the concept of combining different analgesic modalities that work through different mechanisms of action to achieve better pain relief while reducing opioid consumption as well as drug-related adverse effects [6,7,8]. Since its introduction in 1993 by Kehlet and Dahl [9], multimodal analgesia has been extensively studied but few studies had ever investigated how multimodal analgesics work together to alter postoperative pain over time after hepatic cancer surgery. It is of interest and importance to guide clinical pain management after hepatic cancer surgery with the aid of a trajectory analytical tool like the latent curve model [10] for better interpretation of variations in postoperative pain over time [11]. This study aimed to investigate the influential factors of postoperative pain trajectories and morphine consumption after hepatic cancer surgery with a particular interest in multimodal analgesia

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Methods

Results

Conclusion