Peri- and postoperative analgesic strategies in live donor hepatectomy: A national survey

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).