Orthotopic liver transplantation (OLT) recipients have been reported to have decreased
perioperative opioid and intraoperative inhalational anesthetic requirements when compared to
patients without liver disease undergoing other types of major abdominal surgeries. The severity of
the liver disease and the process of the transplantation itself may alter the pharmacokinetic and
pharmacodynamic effects of different pain medications. Chemical injury of the liver and the high
degree of surgical stress may also increase the levels of neuropeptides involved in pain modulation.
Per the U.S. Department of Health and Human Services Organ Procurement and Transplantation
Network, more than 5,000 OLT cases are being done per year since 2000. With better understanding
of the pathophysiology of liver disease and the development of perioperative anesthesia management, the recent concept
of improving patient outcome following OLT includes a fast-track approach in selected patients, which may shorten or
completely bypass intensive care unit stay and reduce costs. With this development, the understanding of the analgesic
pharmacology in the care of the OLT patients is even more important. Proper dosage of medications can achieve adequate
intraoperative anesthetic depth and postoperative pain control, while avoiding over-sedation which increases risk of
prolonged postoperative mechanical ventilation. The purpose of this review is to summarize the pharmacokinetics and
pharmacodynamics of the analgesic medications commonly administered to this patient population.
Keywords: Analgesia, end-stage liver disease, hepatic failure, hepatic function, opioid, orthotopic liver transplantation, pain
control, pain medication.
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