Chuttani Priyanka, Sindwani Gaurav, Pamecha Viniyendra, Mohapatra Nihar, Arora Mahesh Kumar
Department of Anaesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India.
Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, New Delhi, India.
Clin Transplant Res. 2025 Jun 30;39(2):142-149. doi: 10.4285/ctr.24.0054. Epub 2025 Apr 3.
Managing pain after liver transplantation presents unique challenges. The severity of this pain may correspond to elevated endogenous opioid peptide levels, which in turn depend on the severity of liver disease, as represented by the Model for End-Stage Liver Disease (MELD) score. Hence, this study aimed to assess the difference in fentanyl consumption after liver transplantation between patients with high and low MELD scores.
Patients meeting the inclusion criteria and scheduled for living donor liver transplantation were prospectively recruited. A standard anesthesia protocol was followed for intraoperative management. Postoperatively, intravenous patient-controlled analgesia was initiated. Visual analogue scores, fentanyl consumption, sedation levels, and complications such as pruritus, nausea, and vomiting were recorded.
A total of 40 patients were included. The patients were divided into low-MELD (<25) and high-MELD (≥25) groups, with 20 patients in each. Fentanyl consumption was significantly higher in the low-MELD group on both postoperative day (POD) 1 (118.00±11.16 vs. 62.25±11.16 μg, P=0.001) and POD 2 (59.00±7.41 vs. 18.00±7.41 μg, P<0.001). Similarly, pain at rest was significantly higher in the low-MELD group on POD 1 (39.29±1.01 vs. 35.70±1.01, P=0.019) and POD 2 (28.21±1.01 vs. 22.78±1.00, P=0.001).
Among patients with chronic liver disease undergoing living donor liver transplantation, postoperative fentanyl consumption and pain scores were significantly lower in those with a high MELD score compared to patients with a low MELD score.
肝移植术后疼痛管理存在独特挑战。这种疼痛的严重程度可能与内源性阿片肽水平升高有关，而内源性阿片肽水平又取决于终末期肝病模型（MELD）评分所代表的肝病严重程度。因此，本研究旨在评估MELD评分高和低的患者肝移植后芬太尼消耗量的差异。
前瞻性招募符合纳入标准并计划进行活体肝移植的患者。术中管理遵循标准麻醉方案。术后开始静脉自控镇痛。记录视觉模拟评分、芬太尼消耗量、镇静水平以及瘙痒、恶心和呕吐等并发症。
共纳入40例患者。患者分为低MELD（<25）组和高MELD（≥25）组，每组20例。低MELD组在术后第1天（POD 1）（118.00±11.16 vs. 62.25±11.16 μg，P = 0.001）和POD 2（59.00±7.41 vs. 18.00±7.41 μg，P<0.001）的芬太尼消耗量均显著更高。同样，低MELD组在POD 1（39.29±1.01 vs. 35.70±1.01，P = 0.019）和POD 2（28.21±1.01 vs. 22.78±1.00，P = 0.001）的静息痛也显著更高。
在接受活体肝移植的慢性肝病患者中，与低MELD评分患者相比，高MELD评分患者术后芬太尼消耗量和疼痛评分显著更低。
