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Predictors of Post-operative Pain and Opioid Consumption in Patients Undergoing Liver Surgery

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Abstract

Background

Post-operative pain management is a critical component of perioperative care. Patients at risk of poorly controlled post-operative pain may benefit from early measures to optimize pain management. We sought to identify risk factors for post-operative pain and opioid consumption in patients undergoing liver resection.

Methods

This is a multi-institutional prospective nested cohort study of patients undergoing open liver resection. Opioid consumption and pain scores were collected following surgery. To estimate the effects of patient factors on opioid consumption (oral morphine equivalents—OME) and on pain scores (NRS-11), we used generalized linear models and multivariable linear regression model, respectively.

Results

One hundred and fifty-three patients who underwent open liver resection between 2013 and 2016 were included in the study. The mean patient age was 62.2 years, and 43.3% were female. Younger patients were significantly more likely to use more opioids in the early post-operative period (16.7 OME/10 years, p < 0.001). Patient factors that were significantly associated with increased NRS-11 pain scores also included younger patient age (difference in pain score of 0.3/10 years with cough and 0.2/10 years at rest, p < 0.01 for both) as well as a history of analgesic use (difference in pain score of 0.9 with cough and 0.6 at rest, p < 0.01 and p = 0.07, respectively).

Conclusion

Younger patients and those with a history of analgesic use are more likely to report higher post-operative pain and require higher doses of opioids. Early identification of these patients, and measures to better manage their pain, may contribute to optimal perioperative care.

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Acknowledgements

Support for the randomized controlled trial of MOTAP catheter analgesia, the data from which were used for this study, was provided by the Innovation Fund of the Alternative Funding Plan from the Academic Health Sciences Centres of Ontario. Dr. Karanicolas is supported by a Canadian Institute of Health Research (CIHR) New Investigator Award. Dr. Clarke is supported by a University of Toronto, Department of Anesthesia Research Merit Award.

Funding

Funding for the randomized controlled trial from which data were used in this nested cohort study was provided by the Academic Health Science Centre (AHSC) Alternative Funding Plan (AFP) Innovation Grant

Author information

Authors and Affiliations

  1. Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, T2-016, Toronto, ON, M4N3M5, Canada

    R. Behman, N. Coburn, C. Law, J. Hallet & P. J. Karanicolas

  2. Department of Surgery, University Health Network, University of Toronto, Toronto, Canada

    S. Cleary, A. C. Wei & P. Greig

  3. Department of Anaesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada

    P. McHardy & J. Sawyer

  4. Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada

    A. Kiss, N. Coburn, C. Law & P. J. Karanicolas

  5. Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Canada

    S. S. J. Ladak, J. Katz & H. Clarke

  6. Pain Research Unit, Toronto General Hospital, University Health Network, Toronto, Canada

    S. A. McCluskey, C. Srinivas, J. Katz & H. Clarke

  7. Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, USA

    S. Cleary

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  1. R. Behman
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  2. S. Cleary
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  3. P. McHardy
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  4. A. Kiss
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  5. J. Sawyer
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  6. S. S. J. Ladak
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  7. S. A. McCluskey
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  8. C. Srinivas
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  9. J. Katz
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  10. N. Coburn
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  11. C. Law
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  12. A. C. Wei
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  13. P. Greig
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  14. J. Hallet
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  15. H. Clarke
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  16. P. J. Karanicolas
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Correspondence to P. J. Karanicolas.

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Behman, R., Cleary, S., McHardy, P. et al. Predictors of Post-operative Pain and Opioid Consumption in Patients Undergoing Liver Surgery. World J Surg 43, 2579–2586 (2019). https://doi.org/10.1007/s00268-019-05050-7

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  • DOI: https://doi.org/10.1007/s00268-019-05050-7

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