Morphine vs. Fentanyl Patient Controlled Analgesia for Postoperative Pain Control in Major Hepatic Resection Surgeries Including Living Liver Donors

Abstract

Background: Liver resection surgery results in significant postoperative pain. However, it is still not clear which opioids used by Patient Controlled Analgesia (PCA) provides the best pain control and results in the least side effect in a patient with impaired liver function. Our hypothesis was that fentanyl is a better choice than morphine as it is a potent analgesic that its elimination half-life does not depend on the hepatic uptake and metabolism. The Study Purpose: Is to compare Morphine and Fentanyl PCA in liver resection patients as regards the degree of pain control, the consumption of Opioids and the side effects. Methods: A retrospective case control study of hepatic resection patients who received postoperative morphine (Morph) or Fentanyl (Fent) (PCA). The study compared the pain scores, morphine equivalent dose (MED), the number of demands requested as recorded by the PCA infusion pump and the side effects every 12 hours for 48 hours. Results: The study yielded 40 patients; with the majority were living donor hepatic resection patients. There was no significant difference in the pain scores. However, the MED and the demands were significantly less in the Morph group. p value<0.000, 0.0001, 0.0005, 0,003, demands p<0.002, 0.006, 0.014, 0.013 at 12, 24, 48, 36 hours respectively. The overall side effects were not different between the 2 groups at all-time intervals measured, however Morph patients were significantly more sedated in the first 12 hours.