Crest Peyton, Zeiner Sebastian, Stacey Piper, Kronish Kate, Lin Rachel, Roberts John P, Adelmann Dieter
Department of Surgery, University of California, San Francisco, California, USA.
Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, USA.
Liver Transpl. 2025 Jun 6. doi: 10.1097/LVT.0000000000000650.
Donor safety is of paramount importance in live donor hepatectomy, and acute pain is the most frequent complaint reported by donors. There are various approaches to managing perioperative and postoperative pain following live donor hepatectomy. These include the administration of opioid and nonopioid analgesics and neuraxial, regional, and local anesthesia. However, there is limited data on the practice patterns of pain management for live donor hepatectomy, particularly when comparing left and right lobe hepatectomies. A national electronic survey was administered to active living donor liver transplant centers in the United States, identified via the Organ Procurement and Transplantation Network directory. The survey focused on demographics, perioperative and postoperative pain management strategies, and differences in pain management practices based on left versus right lobe hepatectomies and surgical approach. We received responses from 37 centers (86%). The majority of centers (67.6%) performed both right and left live donor hepatectomies. Most centers had protocolized perioperative (78.4%) and postoperative (83.8%) pain management guidelines. Perioperatively, most centers utilized a multimodal approach, based on intravenous fentanyl and/or hydromorphone combined with nonopioid adjuncts. Acetaminophen was the most common postoperative analgesic for both right (75.7%) and left (80%) lobe donors. Transversus abdominis plane blocks were the most frequently used regional anesthesia technique for both right (43.2%) and left (48%) lobe donors. Epidural catheters were placed more frequently in left (40%) than in right (32.4%) lobe donors. We observed a significant variation in perioperative and postoperative pain management strategies after live donor hepatectomy between centers. Some centers adapt analgesic techniques based on the surgical technique (eg, open vs. laparoscopic/robotic, and right vs. left lobe hepatectomy).
供体安全在活体供肝肝切除术中至关重要，急性疼痛是供体报告的最常见主诉。对于活体供肝肝切除术后的围手术期和术后疼痛管理有多种方法。这些方法包括使用阿片类和非阿片类镇痛药以及神经轴阻滞、区域麻醉和局部麻醉。然而，关于活体供肝肝切除术后疼痛管理的实践模式的数据有限，特别是在比较左、右半肝切除术时。对通过器官获取与移植网络目录识别出的美国活跃的活体供肝肝移植中心进行了一项全国性电子调查。该调查聚焦于人口统计学、围手术期和术后疼痛管理策略，以及基于左、右半肝切除术和手术方式的疼痛管理实践差异。我们收到了37个中心的回复（回复率86%）。大多数中心（67.6%）同时进行右、左半肝活体供肝切除术。大多数中心有围手术期（78.4%）和术后（83.8%）疼痛管理方案。围手术期，大多数中心采用多模式方法，基于静脉注射芬太尼和/或氢吗啡酮并联合非阿片类辅助药物。对右半肝（75.7%）和左半肝（80%）供体而言，对乙酰氨基酚是最常用的术后镇痛药。腹横肌平面阻滞是右半肝（43.2%）和左半肝（48%）供体最常用的区域麻醉技术。左半肝（40%）供体比右半肝（32.4%）供体更频繁地放置硬膜外导管。我们观察到各中心在活体供肝肝切除术后的围手术期和术后疼痛管理策略上存在显著差异。一些中心根据手术技术（如开放手术与腹腔镜/机器人手术，以及右半肝与左半肝切除术）调整镇痛技术。
