Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 May;46(5):433-445.
doi: 10.1136/rapm-2020-101933. Epub 2021 Jan 12.

Pain management after open liver resection: Procedure-Specific Postoperative Pain Management (PROSPECT) recommendations

Audrey Dieu #  1 , Philippe Huynen #  2 , Patricia Lavand'homme  3 , Hélène Beloeil  4 , Stephan M Freys  5 , Esther M Pogatzki-Zahn  6 , Girish P Joshi  7 , Marc Van de Velde  2   8 ; PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy (ESRA)
Affiliations
Review

Pain management after open liver resection: Procedure-Specific Postoperative Pain Management (PROSPECT) recommendations

Audrey Dieu et al. Reg Anesth Pain Med. 2021 May.

Abstract

Background and objectives: Effective pain control improves postoperative rehabilitation and enhances recovery. The aim of this review was to evaluate the available evidence and to develop recommendations for optimal pain management after open liver resection using Procedure-Specific Postoperative Pain Management (PROSPECT) methodology.

Strategy and selection criteria: Randomized controlled trials (RCTs) published in the English language from January 2010 to October 2019 assessing pain after liver resection using analgesic, anesthetic or surgical interventions were identified from MEDLINE, Embase and Cochrane databases.

Results: Of 121 eligible studies identified, 31 RCTs and 3 systematic reviews met the inclusion criteria. Preoperative and intraoperative interventions that improved postoperative pain relief were non-steroidal anti-inflammatory drugs, continuous thoracic epidural analgesia, and subcostal transversus abdominis plane (TAP) blocks. Limited procedure-specific evidence was found for intravenous dexmedetomidine, intravenous magnesium, intrathecal morphine, quadratus lumborum blocks, paravertebral nerve blocks, continuous local anesthetic wound infiltration and postoperative interpleural local anesthesia. No evidence was found for intravenous lidocaine, ketamine, dexamethasone and gabapentinoids.

Conclusions: Based on the results of this review, we suggest an analgesic strategy for open liver resection, including acetaminophen and non-steroidal anti-inflammatory drugs, combined with thoracic epidural analgesia or bilateral oblique subcostal TAP blocks. Systemic opioids should be considered as rescue analgesics. Further high-quality RCTs are needed to confirm and clarify the efficacy of the recommended analgesic regimen in the context of an enhanced recovery program.

Keywords: analgesia; pain; pain management; postoperative.

PubMed Disclaimer

Conflict of interest statement

Competing interests: GJ has received honoraria from Baxter and Pacira Pharmaceuticals. FB has received honoraria from Pfizer, The Medicine Company, Abbott France, Nordic Pharma France, Heron therapeutics, AMBU and Grunenthal. MVdV has received honoraria from Sintetica, Grunenthal, Vifor Pharma, MSD, Nordic Pharma, Janssen Pharmaceuticals, Heron Therapeutics and Aguettant. EP-Z has received honoraria form Mundipharma, Grunenthal, MSD, Janssen-Cilag GmbH, Fresenius Kabi and AcelRx.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. ERAS, enhanced recovery after surgery; RCT, randomized controlled trial.
See this image and copyright information in PMC

References

    1. Day RW, Aloia TA. Enhanced recovery in liver surgery. J Surg Oncol 2019;119:660–6. 10.1002/jso.25420 - DOI - PubMed
    1. Nadalin S, Capobianco I, Panaro F, et al. . Living donor liver transplantation in Europe. Hepatobiliary Surg Nutr 2016;5:159–75. 10.3978/j.issn.2304-3881.2015.10.04 - DOI - PMC - PubMed
    1. Chang SB, Palavecino M, Wray CJ, et al. . Modified Makuuchi incision for foregut procedures. Arch Surg 2010;145:281–4. 10.1001/archsurg.2010.7 - DOI - PubMed
    1. Yip VS, Dunne DFJ, Samuels S, et al. . Adherence to early mobilisation: key for successful enhanced recovery after liver resection. Eur J Surg Oncol 2016;42:1561–7. 10.1016/j.ejso.2016.07.015 - DOI - PubMed
    1. Joshi GP, Kehlet H. Postoperative pain management in the era of ERas: an overview. Best Pract Res Clin Anaesthesiol 2019;33:259–67. 10.1016/j.bpa.2019.07.016 - DOI - PubMed

Publication types

Substances