الفهرس 
Introduction
Liver TransplantationOnly 14 pages are availabe for public view
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Abstract
Summary
Postoperative pain (POP) represents a major challenge in the management of surgical patients, as it is highly common after major surgeries and is associated with increased morbidity and mortality.
POP and its impact on patients who underwent liver transplantation (LT) is poorly understood.
The aim of this study was undertaken to investigate the incidence, assessment of POP, and clinical outcomes of patients with high level of postoperative pain in LT.
This retrospective, cohort study was carried out in University of California, Los Anglos (UCLA). After IRB approval, adult LT patients between March 2013 and September 2015 at our center were retrospectively reviewed. All patients who were extubated in the first week following LT were included. Pain score (0 to 10) during the first seven days post-extubation was assessed by numerical rating scale and recorded. Patients were divided into two groups: postoperative low to moderate pain score (PLMPS) reported pain score from (0-6) and postoperative high pain score (PHPS) from (7-10). The two groups were compared using univariate analysis and independent risk factors were identified by multivariate logistic regression. Of 424 patients who underwent LT during this period, 272 were extubated within the first postoperative week and were included in the analysis.
The result of this study showed that a total of 114 (41.9%) patients reported pain score at 7 or higher during 7 days following extubation and 158 patients (58.1%) reported pain score ”between 0 to 6” during the same period. There were no significant differences regarding to age, gender, MELD score, surgery time, intraoperative blood transfusion, vasopressor use and renal replacement therapy between the PLMPS and PHPS groups. However, patients in the PHPS group had a higher dose of hydromorphone (6.2±7.1 vs. 3.4±4.3, p=0.001), oral morphine equivalent (233.9±302.7 vs 132.6±309.8, p=0.008), and longer hospital stay after LT compared with those in the PLMPS group (44.2±46.3 days vs 30.7± 26.6, p=0.006). Using multivariate logistic regression analysis, PHPS was independent risk factor for prolonged (>30 days) hospital stay after LT (OR 2.0 95% CI 1.04-3.83, p=0.04). Other independent risk factors for prolonged hospital stay after LT include preoperative encephalopathy, renal replacement therapy, and graft failure.
from the findings of the present study, PHPS was reported to affect 41.9% of adult LT patients. Patients with PHPS had high doses of hydromorphone, oral morphine equivalent and prolonged hospital stay after LT than patients with PLMPS. Out findings, highlight the importance of pain incidence, assessment and management after LT.
There are some recommendations for this study;
First, those out findings highlight the importance of pain incidence, assessment and management after LT.
Second, we recommend further studies to be carried out with more confounding factors and outcomes for PHPS.
Third, using of hydromorphone in treatment of patients with high level of postoperative pain has a beneficial role in their pain management.