Skip to main content
SpringerLink
Log in

Perioperative Pain Management for Hepatopancreaticobiliary Surgery

  • Chapter
  • First Online:
Optimizing Outcomes for Liver and Pancreas Surgery

  • 814 Accesses

Abstract

Optimal perioperative pain management for patients undergoing hepatobiliary and pancreatic surgery requires a team-based approach using multimodal therapy and regional analgesia. Opioid-sparing regimens that include acetaminophen and gabapentin can improve postoperative outcomes. Regional anesthetic techniques (epidural and TAP blocks) are an important component of pain management strategies. This current chapter will review the most current evidence-based techniques and medication regimens for providing superior postoperative pain control while avoiding adverse effects of analgesic therapies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Bibliography

  1. Weinbroum AA. Non-opioid IV adjuvants in the perioperative period: pharmacological and clinical aspects of ketamine and gabapentinoids. Pharmacol Res [Internet]. 2012;65(4):411–29. Available from: http://dx.doi.org/10.1016/j.phrs.2012.01.002

    Article  CAS  Google Scholar 

  2. Aarts M, Okrainec A, Wood T. Enhanced recovery after surgery guideline. Minerva Anestesiol. 2014;80(11):1228–33.

    Google Scholar 

  3. Kehlet H, Dahl JB. The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth Analg. 1993;77:1048–56.

    Article  CAS  PubMed  Google Scholar 

  4. Ong CKS, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg. 2010;110(4):1170–9.

    CAS  PubMed  Google Scholar 

  5. DAHL JB, Nielsen RV, Wetterslev J, Nikolajsen L, Hamunen K, Kontinen VK, et al. Post-operative analgesic effects of paracetamol, NSAIDs, glucocorticoids, gabapentinoids and their combinations: a topical review. Acta Anaesthesiol Scand [Internet]. 2014;58(10):1165–81. Available from: http://doi.wiley.com/10.1111/aas.12382

    Article  CAS  PubMed  Google Scholar 

  6. Khan JS, Margarido C, Devereaux PJ, Clarke H, McLellan A, Choi S. Preoperative celecoxib in noncardiac surgery. Eur J Anaesthesiol [Internet]. 2016;33(3):204–14. Available from: http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L608161736%255Cn. http://dx.doi.org/10.1097/EJA.0000000000000346%255Cn. http://findit.library.jhu.edu/resolve?sid=EMBASE&issn=13652346&id=doi:10.1097%252FEJA.0000000000000346&atitle=Preo

  7. Rushfeldt CF, Sveinbjørnsson B, Søreide K, Vonen B. Risk of anastomotic leakage with use of NSAIDs after gastrointestinal surgery. Int J Color Dis. 2011;26(12):1501–9.

    Article  Google Scholar 

  8. Kagedan DJ, Ahmed M, Devitt KS, Wei AC. Enhanced recovery after pancreatic surgery: a systematic review of the evidence. HPB. 2015;17(1):11–6.

    Article  PubMed  Google Scholar 

  9. Tan M, Law LS-C, Gan TJ. Optimizing pain management to facilitate Enhanced recovery after surgery pathways. Can J Anaesth [Internet]. 2014;62(2):203–18. Available from: http://link.springer.com/10.1007/s12630-014-0275-x

    Article  PubMed  Google Scholar 

  10. Hughes MJ, Harrison EM, Jin Y, Homer N, Wigmore SJ. Acetaminophen metabolism after liver resection: a prospective case-control study. Dig Liver Dis [Internet]. 2015;47(12):1039–46. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26362614

  11. Thorpe A, Taylor C. Calcium channel a2–d ligands: gabapentin and pregabalin. In: Taylor J, Triggle D, editors. Comprehensive medical chemistry II. 1st ed. Oxford: Elsevier; 2007. p. 227–46.

    Google Scholar 

  12. NIH. Gabapentin [Internet]. PubChem. Open Chemistry Database. 2016 [cited 2016 Jan 1]. Available from: https://pubchem.ncbi.nlm.nih.gov/compound/gabapentin#section=Top.

  13. Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA [Internet]. 1998;280(21):1837–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9846778

  14. Backonja M, Beydoun A, Edwards KR, Schwartz SL, Fonseca V, Hes M, et al. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA [Internet]. 1998;280(21):1831–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9846777

  15. Chang CY, Challa CK, Shah J, Eloy JD. Gabapentin in acute postoperative pain management. Biomed Res Int. 2014;2014(2):1–7.

    Google Scholar 

  16. Doleman B, Heinink TP, Read DJ, Faleiro RJ, Lund JN, Williams JP. A systematic review and meta-regression analysis of prophylactic gabapentin for postoperative pain. Anaesthesia. 2015;70(10):1186–204.

    Article  CAS  PubMed  Google Scholar 

  17. Barletta JF. Clinical and economic burden of opioid use for postsurgical pain: focus on ventilatory impairment and ileus. Pharmacotherapy. 2012;32(9):3–9.

    Google Scholar 

  18. Erstad BL, Puntillo K, Gilbert HC, Grap MJ, Li D, Medina J, et al. Pain management principles in the critically ill. Chest [Internet]. 2009;135(4):1075–86. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19349403

  19. Asgeirsson T, El-badawi KI, Mahmood A, Barletta J, Luchtefeld M, Senagore AJ. Postoperative ileus: it costs more than you expect. J Am Coll Surg [Internet]. 2010;210(2):228–31. Available from: http://dx.doi.org/10.1016/j.jamcollsurg.2009.09.028

    Article  Google Scholar 

  20. Barletta JF, Senagore AJ. Reducing the burden of postoperative ileus: evaluating and implementing an evidence-based strategy. World J Surg. 2014;38(8):1966–77.

    Article  PubMed  Google Scholar 

  21. Barletta JF, Asgeirsson T, Senagore AJ. Influence of intravenous opioid dose on postoperative ileus. Ann Pharmacother. 2011;45(7–8):916–23.

    Article  CAS  PubMed  Google Scholar 

  22. Thompson DR. Narcotic analgesic effects on the sphincter of Oddi: a review of the data and therapeutic implications in treating pancreatitis. Am J Gastroenterol. 2001;96(4):1266–72.

    Article  CAS  PubMed  Google Scholar 

  23. Goff JS. The human sphincter of Oddi. Physiology and pathophysiology. Arch Intern Med [Internet]. 1988;148(12):2673–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3058076

  24. Yu G, Wen Q, Qiu L, Bo L, Yu J. Laparoscopic cholecystectomy under spinal anaesthesia vs. general anaesthesia: a meta-analysis of randomized controlled trials. BMC Anesthesiol [Internet]. 2015;15(1):176. Available from: http://www.biomedcentral.com/1471-2253/15/176

  25. Moraca RJ, Sheldon DG, Thirlby RC. The role of epidural anesthesia and analgesia in surgical practice. Ann Surg. 2003;238(5):663–73.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Tzimas P, Prout J, Papadopoulos G, Mallett SV. Epidural anaesthesia and analgesia for liver resection. Anaesthesia. 2013;68(6):628–35.

    Article  CAS  PubMed  Google Scholar 

  27. Bruns H, Rahbari NN, Löffler T, Diener MK, Seiler CM, Glanemann M, et al. Perioperative management in distal pancreatectomy: results of a survey in 23 European participating centres of the DISPACT trial and a review of literature. Trials. 2009;10:58.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Popping DM, Elia N, Van Aken HK, Marret E, Schug SA, Kranke P, et al. Impact of epidural analgesia on mortality and morbidity after surgery: systematic review and meta-analysis of randomized controlled trials. Ann Surg [Internet]. 2014;259(6):1056–67. Available from: http://shibboleth.ovid.com/secure/?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=24096762 http://sfx.kcl.ac.uk/kings?sid=OVID:medline&id=pmid:&id=doi:10.1097%252FSLA.0000000000000237&genre=article&atitle=Impact+of+epidural+analgesia+on+mortality+and+morbidity

  29. Sugimoto M, Nesbit L, Barton JG, William TL. Epidural anesthesia dysfunction is associated with postoperative complications after pancreatectomy. J Hepatobiliary Pancreat Sci. 2016;23(2):102–9.

    Article  PubMed  Google Scholar 

  30. Clark CJ, Ali SM, Zaydfudim V, Jacob AK, Nagorney DM. Safety of an enhanced recovery pathway for patients undergoing open hepatic resection. PLoS One [Internet]. 2016;11(3):e0150782. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26950852

  31. De Pietri L, Siniscalchi A, Reggiani A, Masetti M, Begliomini B, Gazzi M, et al. The use of intrathecal morphine for postoperative pain relief after liver resection: a comparison with epidural analgesia. Anesth Analg. 2006;102(4):1157–63.

    Article  PubMed  Google Scholar 

  32. Kasivisvanathan R, Abbassi-Ghadi N, Prout J, Clevenger B, Fusai GK, Mallett SV. A prospective cohort study of intrathecal versus epidural analgesia for patients undergoing hepatic resection. HPB. 2014;16(8):768–75.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Yarwood J, Berrill A. Nerve blocks of the anterior abdominal wall. Contin Educ Anaesth Crit Care Pain. 2010;10(6):182–6.

    Article  Google Scholar 

  34. Jakobsson J, Wickerts L, Forsberg S, Ledin G. Transversus abdominal plane (TAP) block for postoperative pain management: a review. F1000Res [Internet]. 2015;4(F1000 Faculty Rev):1359. Available from: http://f1000research.com/articles/4-1359/v1

    Google Scholar 

  35. Abdallah FW, Laffey JG, Halpern SH, Brull R. Duration of analgesic effectiveness after the posterior and lateral transversus abdominis plane block techniques for transverse lower abdominal incisions: a meta-analysis. Br J Anaesth. 2013;111(5):721–35.

    Article  CAS  PubMed  Google Scholar 

  36. Keir A, Rhodes L, Kayal A, Khan OA. Does a transversus abdominis plane (TAP) local anaesthetic block improve pain control in patients undergoing laparoscopic cholecystectomy? A best evidence topic. Int J Surg [Internet]. 2013;11(9):792–4. Available from: http://dx.doi.org/10.1016/j.ijsu.2013.05.039

    Article  Google Scholar 

  37. Arcidiacono PG, Calori G, Carrara S, McNicol ED, Testoni PA. Celiac plexus block for pancreatic cancer pain in adults. Cochrane Database Syst Rev. 2011;3:CD007519. doi: 10.1002/14651858.CD007519.pub2. Review. PubMed PMID: 21412903.

  38. Bell R, Pandanaboyana S, Prasad KR. Epidural versus local anaesthetic infiltration via wound catheters in open liver resection: a meta-analysis. ANZ J Surg. 2015;85(1–2):16–21.

    Article  PubMed  Google Scholar 

  39. Reddi D. Preventing chronic postoperative pain. Anaesthesia. 2016;71:64–71.

    Article  PubMed  Google Scholar 

  40. Pai S-L, Aniskevich S, Rodrigues ES, Shine TS. Analgesic considerations for liver transplantation patients. Curr Clin Pharmacol [Internet]. 2015;10(1):54–65. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24521192

  41. Hughes MJ, McNally S, Wigmore SJ. Enhanced recovery following liver surgery: a systematic review and meta-analysis. HPB (Oxford) [Internet]. 2014;16(8):699–706. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24661306

  42. Melloul E, Hübner M, Scott M, et al. Guidelines for perioperative care for liver surgery: Enhanced Recovery After Surgery (ERAS) society recommendations. World J Surg. 2016;40(10):2425–40. doi:10.1007/s00268-016-3700-1.

  43. Marret E, Rolin M, Beaussier M, Bonnet F. Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. Br J Surg. 2008;95(11):1331–8.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Wake Forest Baptist Health, Winston-Salem, NC, USA

    Clancy J. Clark MD

Authors
  1. Clancy J. Clark MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Clancy J. Clark MD .

Editor information

Editors and Affiliations

  1. Virginia Mason Medical Center, Seattle, Washington, USA

    Flavio G. Rocha

  2. Wake Forest Baptist Health, Winston-Salem, North Carolina, USA

    Perry Shen

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Clark, C.J. (2018). Perioperative Pain Management for Hepatopancreaticobiliary Surgery. In: Rocha, F., Shen, P. (eds) Optimizing Outcomes for Liver and Pancreas Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-62624-6_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-62624-6_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-62623-9

  • Online ISBN: 978-3-319-62624-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation