Altered hematologic profiles following donor right hepatectomy and implications for perioperative analgesic management

Roman Schumann, Luis Zabala, Michael Angelis, Iwona Bonney, Hocine Tighiouart, Daniel B. Carr

Research output: Contribution to journalArticlepeer-review

60 Scopus citations

Abstract

Living liver donors for adult liver transplant recipients undergo extensive liver resection. Partial donor hepatectomies may alter postoperative drug metabolism and hemostasis; thus, the risks and the benefits of pain management for this unique patient population may need to be reassessed. The safety and efficacy of combined epidural analgesia and field infiltration in our initial living liver donor group are presented. A thoracic epidural catheter was placed before general anesthesia in 2 female and 6 male donors (44.2 ± 11.3 years old, mean ± standard deviation [SD], range 26 -56). At the end of surgery, incisions were infiltrated (bupivacaine 0.25%), and an epidural infusion was used (bupivacaine 0.1% + hydromorphone hydrochloride 0.02%). Clinical outcomes were followed for 5 days. The time sequence of pain intensity on a 0-10 visual analog scale clustered into 3 phases, the intensity of which differed significantly from each other (2.2 ± 0.6, 0.69 ± 0.2, and 2.37 ± 0.3 respectively, P = 0.028). Right shoulder pain was observed in 75% of the donors. Sedation, pruritus, and nausea were minimal. Consistently maximal international normalized ratio elevation occurred at 17.6 ± 7 hours postoperatively, then slowly declined. Platelet counts were lowest on day 3. No neurologic injury or local anesthetic toxicity was observed. This 2-site approach provided effective, safe, postoperative analgesia for our donors. Universally, coagulopathy ensued, indicating a potentially increased risk for epidural hemorrhage at epidural catheter removal and mandating dose postoperative neurologic and laboratory monitoring. Research is needed to advance the understanding of postoperative coagulopathy and hepatic dysfunction in these donors to further optimize their peri-operative management, including that of analgesia.

Original languageEnglish (US)
Pages (from-to)363-368
Number of pages6
JournalLiver Transplantation
Volume10
Issue number3
DOIs
StatePublished - Mar 1 2004

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

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