Introduction

Clinicians at 9 A2ALL centers were surveyed about practices and attitudes toward pain control after donor hepatectomy.

Methods

Responses were collected via Survey Monkey. A surgeon (S), anesthesiologist (A), and nurse (N) involved in pain control of LD after surgery at each center were queried. Respondents identified their role and center, but results were otherwise anonymous.

Results

Responses were received from 11 S, 9 N, 7 A, and 1 NP. 6 centers had responses from each, 2 from S and N, and 1 only from S. All centers had an acute pain team (APT) but APT involvement was low due to lack of experience with LD (2), restricted availability of APT (5), no relationship between APT and transplant team (5), and unwillingness of APT to work with techniques favored by LD surgeon (4).

Most (19) had >7 years experience (S=9, N=6,A=4). 75% indicated single protocol for pain control in their center. All donors were seen by A pre-op, but actual education regarding post-op pain was done by S(79%) + N(56%) more often than A(39%).

S (94%) + A (78%) were main contributors to LD pain protocol. IVPCA, epidural, and local infiltration were most common early pain regimens; oral opioids and NSAIDs were used later. 70% of centers changed pain protocol at least once. Protocols involving epidural or intrathecal routes were stopped most frequently due to complications. All groups believed LD received adequate pain monitoring on floors; 60% used continuous monitoring (58% pulse oximetry, 66% EKG, 29% BP). S were responsible for pain control most often (43%) unless epidural used. Routine assessment of LD pain was conducted by N (89%) and S (100%) with A involvement related to failure of current regimen.

45% S believe LD experience more severe pain than other liver resection (LR) patients but 71% of A disagreed. S(54%)+A(30%) believe LDs had more pain related emotional distress than other LRs but N(90%) disagreed. S+A(64, 71%) believed LD pain is undertreated due to fear of complications; N had no consensus. 75% feel donors are satisfied with pain control but only 46% conduct patient satisfaction survey.

Conclusions

1. LD pain regimens are not uniform across centers, but centers follow single pain protocol. 2. Surgeons most frequently develop/implement LD pain protocols. 3. Preoperative LD pain education is performed by S and N. 4. Inconsistency is noted between reported under treatment of LD pain related to fear of adverse events and belief that LD pain is adequately controlled.

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