Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 28, 2015; 7(21): 2331-2335
Published online Sep 28, 2015. doi: 10.4254/wjh.v7.i21.2331
Analgesia after liver transplantation
Zoka Milan
Zoka Milan, King’s College Hospital, SE5 9RS London, United Kingdom
Zoka Milan, King’s College School of Medicine, SE5 9RS London, United Kingdom
Author contributions: Milan Z designed research, performed research, analyzed data, wrote the paper.
Conflict-of-interest statement: There is no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Zoka Milan, MD, PhD, FRCA, FRCIM, Consultant Anaesthetist, Honorary Senior Lecturer, Visiting Professor, King’s College Hospital, Denmark Hill, SE5 9RS London, United Kingdom.
Telephone: +44-203-329990000
Received: April 14, 2015
Peer-review started: April 16, 2015
First decision: May 18, 2015
Revised: May 26, 2015
Accepted: September 2, 2015
Article in press: September 7, 2015
Published online: September 28, 2015

This article addresses postoperative analgesia in patients with end-stage liver disease who have undergone liver transplantation (LT). Postoperative analgesia determines how patients perceive LT. Although important, this topic is underrepresented in the current literature. With an increased frequency of fast tracking in LT, efficient intra- and postoperative analgesia are undergoing changes. We herein review the current literature, compare the benefits and disadvantages of the therapeutic options, and make recommendations based on the current literature and clinical experience.

Keywords: Liver transplant, Analgesia, Fast-track, Opioid, Postoperative

Core tip: Based on several papers published over the last two decades, there is a general assumption that pain following liver transplantation (LT) is less intense than pain following other major abdominal procedures and that the postoperative opioid consumption is lower than for other hepatobiliary procedures. There is also an assumption that patient-controlled opioid analgesia is the only mode of postoperative analgesia for this group of patients. In this paper, we challenged that opinion and addressed the specificity of postoperative pain intensity and treatment in LT patients. We also explored all options in pain control, in addition to patient-controlled analgesia, including epidural analgesia, transversus abdominis plane block and wound catheter infiltration.