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. 2020 Sep;6(3):243-252.
doi: 10.5114/ceh.2020.99521. Epub 2020 Sep 30.

Can adequate analgesia be achieved in patients with cirrhosis without precipitating hepatic encephalopathy? A prospective study

Ashley Bloom  1 , Vanessa Weerasinghe Mudiyansalage  2 , Anna Rhodes  2 , Malcolm Hogg  3 , Chatura Jayasekera  2 , Alexandra Gorelik  4 , Siddharth Sood  2   5 , Amanda Nicoll  1   2
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Can adequate analgesia be achieved in patients with cirrhosis without precipitating hepatic encephalopathy? A prospective study

Ashley Bloom et al. Clin Exp Hepatol. 2020 Sep.

Abstract

Aim of the study: Analgesic use in patients with liver cirrhosis can be associated with increased morbidity and mortality and presents clinicians with a significant and challenging management issue. We evaluated the efficacy of opiate analgesia in patients with cirrhosis, while closely monitoring the side effect profile.

Material and methods: This prospective cohort pilot study compared inpatients with cirrhosis who required regular opiate analgesia to non-cirrhotic patients requiring opiates and patients with cirrhosis who did not require opiates. Participants completed daily surveys to assess for analgesic efficacy and encephalopathy.

Results: Fifty-two patients were initially recruited, of whom 50 patients were analysed in three groups (40 male, 10 female, median age 52 years). These included 13 cirrhotic patients (69% Child-Pugh B or C) requiring regular opiate analgesia, 18 cirrhotic patients (67% Child-Pugh B or C) not receiving regular opiate analgesia, and 19 non-cirrhotic controls. Two patients were excluded due to past stroke and acquired brain injury. All cirrhotic patients received regular lactulose. There was no statistical difference in the adequacy of analgesia between the three groups. The modified orientation log score for encephalopathy remained in the normal range in all but two cirrhotic patients receiving regular opiate analgesia.

Conclusions: Effective pain control is achievable with opiate analgesia in most patients with advanced liver disease without precipitating hepatic encephalopathy.

Keywords: Brief Pain Inventory; liver disease; modified orientation log; pain; sedation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart of patients included in this prospective study
Fig. 2
Fig. 2
A) Median pain severity. Depicts the median pain severity as assessed by the Brief Pain Inventory (BPI) over the 6-day study period by participant group. Group 1 – cirrhotic patients who received regular opiate analgesia, group 2 – cirrhotic patients who did not receive regular opiate analgesia, group 3 – patients without cirrhosis who received regular opiate analgesia. B) Median pain interference. Depicts the median pain interference as assessed by the Brief Pain Inventory (BPI) over the 6-day study period by participant group. Group 1 – cirrhotic patients who received regular opiate analgesia, group 2 – cirrhotic patients who did not receive regular opiate analgesia, group 3 – patients without cirrhosis who received regular opiate analgesia. C) Median modified orientation log. Depicts the median modified orientation log (MO-Log) over the 6-day study period by participant group. Group 1 – cirrhotic patients who received regular opiate analgesia, group 2 – cirrhotic patients who did not receive regular opiate analgesia, group 3 – patients without cirrhosis who received regular opiate analgesia. A MO-Log score of ≥ 23 demonstrates normal mentation
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