RT Journal Article
SR Electronic
T1 Pain management after open liver resection: Procedure-Specific Postoperative Pain Management (PROSPECT) recommendations
JF Regional Anesthesia & Pain Medicine
JO Reg Anesth Pain Med
FD BMJ Publishing Group Ltd
SP 433
OP 445
DO 10.1136/rapm-2020-101933
VO 46
IS 5
A1 Audrey Dieu
A1 Philippe Huynen
A1 Patricia Lavand'homme
A1 Hélène Beloeil
A1 Stephan M. Freys
A1 Esther M Pogatzki-Zahn
A1 Girish P. Joshi
A1 Marc Van de Velde
A1 ,
YR 2021
UL http://rapm.bmj.com/content/46/5/433.abstract
AB 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.All data relevant to the study are included in the article or uploaded as supplementary information. The authors declare that the data supporting the findings of this study are available within the article.