Role of Opioid-Sparing Techniques in Pain Management for General Surgery Patients With Hepatic Dysfunction: An Observational Cohort Study.

Introduction Patients with hepatic dysfunction undergoing general surgery face significant perioperative risks due to the liver's critical role in drug metabolism and systemic homeostasis. Opioid-sparing techniques may mitigate these risks by reducing opioid consumption and minimizing hepatic complications. Objective The objective of the study was to evaluate the effectiveness of opioid-sparing techniques in pain management for general surgery patients with hepatic dysfunction and their impact on postoperative outcomes. Methodology This observational cohort study was conducted at Lady Reading Hospital, Peshawar, Pakistan, from November 2023 to October 2024. A total of 100 patients with hepatic dysfunction undergoing elective general surgeries were included, with 50 managed using opioid-sparing techniques and 50 receiving opioid-based analgesia. Pain was assessed using the Numeric Rating Scale (NRS) at six, 12, 24, and 48 hours post-surgery. Opioid consumption was quantified as morphine-equivalent doses over 48 hours. Hepatic function parameters (aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin) and postoperative outcomes, including complications and hospital stay, were analyzed. Results Postoperative pain scores were significantly lower in the opioid-sparing group across all time points (e.g., NRS at six hours: 2.9 ± 0.8 vs. 4.5 ± 1.1, p < 0.001). Opioid consumption was reduced by 67% in the opioid-sparing group (4.1 ± 1.5 mg vs. 12.6 ± 3.8 mg,p < 0.001). Hepatic function parameters remained stable in both groups. The opioid-sparing group had shorter hospital stays (3.8 ± 0.9 days vs. 5.1 ± 1.2 days, p < 0.001) and fewer complications, including nausea (12% vs. 30%, p = 0.02) and respiratory depression (0% vs. 10%, p = 0.04). Conclusion Opioid-sparing techniques improve pain management, reduce opioid consumption, and minimize postoperative complications in patients with hepatic dysfunction undergoing general surgery. These findings support incorporating opioid-sparing protocols into perioperative care for this high-risk population.