Skip to main content

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

World Journal of Surgery volume 43, pages 2579–2586 (2019)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. McMahon AJ, Russell IT, Ramsay G et al (1994) Laparoscopic and minilaparotomy cholecystectomy: a randomized trial comparing postoperative pain and pulmonary function. Surgery 115(5):533–539

    CAS  PubMed  Google Scholar 

  2. Ballantyne JC, Carr DB, deFerranti S et al (1998) The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg 86(3):598–612

    CAS  Article  Google Scholar 

  3. Beattie WS, Badner NH, Choi P (2001) Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg 93(4):853–858

    CAS  Article  Google Scholar 

  4. Morrison RS, Magaziner J, McLaughlin MA et al (2003) The impact of post-operative pain on outcomes following hip fracture. Pain 103(3):303–311

    Article  Google Scholar 

  5. Thiels CA, Anderson SS, Ubl DS et al (2017) Wide variation and overprescription of opioids after elective surgery. Ann Surg 266(4):564–573. https://doi.org/10.1097/SLA.0000000000002365

    Article  PubMed  Google Scholar 

  6. Sun EC, Darnall BD, Baker LC, Mackey S (2016) Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period. JAMA Intern Med 176(9):1286–1293. https://doi.org/10.1001/jamainternmed.2016.3298

    Article  PubMed  PubMed Central  Google Scholar 

  7. Waljee JF, Li L, Brummett CM, Englesbe MJ (2017) Iatrogenic opioid dependence in the united states: are surgeons the gatekeepers? Ann Surg 265(4):728–730. https://doi.org/10.1097/SLA.0000000000001904

    Article  PubMed  Google Scholar 

  8. Daoust R, Paquet J, Moore L et al (2017) Incidence and risk factors of long-term opioid use in elderly trauma patients. Ann Surg. https://doi.org/10.1097/sla.0000000000002461

    Article  Google Scholar 

  9. Sekhri S, Arora NS, Cottrell H et al (2017) Probability of opioid prescription refilling after surgery: does initial prescription dose matter? Ann Surg. https://doi.org/10.1097/sla.0000000000002308

    Article  Google Scholar 

  10. Hill MV, Stucke RS, McMahon ML, Beeman JL, Barth RJ (2017) An educational intervention decreases opioid prescribing after general surgical operations. Ann Surg 1:1. https://doi.org/10.1097/sla.0000000000002198

    Article  Google Scholar 

  11. Behman R, McHardy P, Sawyer J, Lam-McCulloch J, Karanicolas PJ (2014) Medial open transversus abdominal plane catheter analgesia: a simple, safe, effective technique after open liver resection. J Am Coll Surg 218(5):e91–e94. https://doi.org/10.1016/j.jamcollsurg.2013.12.054

    Article  PubMed  Google Scholar 

  12. Karanicolas P, Cleary S, McHardy P et al (2014) Medial open transversus abdominis plane (MOTAP) catheters for analgesia following open liver resection: study protocol for a randomized controlled trial. Trials 15(1):241. https://doi.org/10.1186/1745-6215-15-241

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kennedy-Hendricks A, Gielen A, McDonald E, McGinty EE, Shields W, Barry CL (2016) Medication sharing, storage, and disposal practices for opioid medications among US adults. JAMA Intern Med 176(7):1027–1029. https://doi.org/10.1001/jamainternmed.2016.2543

    Article  PubMed  Google Scholar 

  14. Macintyre PE, Jarvis DA (1996) Age is the best predictor of postoperative morphine requirements. Pain 64(2):357–364

    CAS  Article  Google Scholar 

  15. Thomas T, Robinson C, Champion D, McKell M, Pell M (1998) Prediction and assessment of the severity of post-operative pain and of satisfaction with management. Pain 75(2–3):177–185

    CAS  Article  Google Scholar 

  16. Glasson JC, Sawyer WT, Lindley CM, Ginsberg B (2002) Patient-specific factors affecting patient-controlled analgesia dosing. J Pain Palliat Care Pharmacother 16(2):5–21

    Article  Google Scholar 

  17. Chang K-Y, Tsou M-Y, Chan K-H, Sung C-S, Chang W-K (2006) Factors affecting patient-controlled analgesia requirements. J Formos Med Assoc 105(11):918–925. https://doi.org/10.1016/S0929-6646(09)60177-7

    Article  PubMed  Google Scholar 

  18. Kulkarni AR, Pusic AL, Hamill JB et al (2017) Factors associated with acute postoperative pain following breast reconstruction. JPRAS Open 11:1–13. https://doi.org/10.1016/j.jpra.2016.08.005

    Article  PubMed  Google Scholar 

  19. Bohnert ASB, Valenstein M, Bair MJ et al (2011) Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA 305(13):1315–1321. https://doi.org/10.1001/jama.2011.370

    CAS  Article  PubMed  Google Scholar 

  20. Shah A, Hayes CJ, Martin BC (2017) Characteristics of initial prescription episodes and likelihood of long-term opioid use—United States, 2006–2015. MMWR Morb Mortal Wkly Rep 66(10):265–269. https://doi.org/10.15585/mmwr.mm6610a1

    Article  PubMed  PubMed Central  Google Scholar 

  21. Katz J, Seltzer Z (2009) Transition from acute to chronic postsurgical pain: risk factors and protective factors. Expert Rev Neurother 9(5):723–744. https://doi.org/10.1586/ern.09.20

    Article  PubMed  Google Scholar 

Download references

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

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

Authors
  1. R. Behman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Cleary
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. McHardy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Kiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Sawyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. S. J. Ladak
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. A. McCluskey
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C. Srinivas
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J. Katz
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. N. Coburn
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. C. Law
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. A. C. Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. P. Greig
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. J. Hallet
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. H. Clarke
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. P. J. Karanicolas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. J. Karanicolas.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue Date:

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