BACKGROUND: Living Liver Donation (LD) is a highly complex major surgical procedure associated with pain. However, managing pain after LD is difficult, as opioid pharmacokinetics change after a large liver resection. Respiratory depression and perceived pain in LD have not been previously reported.

METHOD: Retrospective medical record review (years 2008-2010) of 23 LDs from four large LDLT centers was conducted by an RN reviewer. POD#0-7 pain scores (1-10 scale), pain medication, and incidence of respiratory depression requiring intervention were assessed.

RESULTS: All LDs received IV opioids after LD, 56% received IV NSAIDS, 26% had an epidural. PO medications increased from 13% to 100% at discharge. LD had mean pain scores of 3.86, 4.52, 4.03, 3.74, 4.81, 4.41, 5.91, and 4.75 from POD #0-7 respectively, however pain scores ranged from 0-10 throughout POD#0-7. The highest reported mean pain scores occurred on POD#6 (5.1). Percentage of pain score assessments > 6 increased on POD#4 (34%), and were highest on POD#6 (48%).

5 LD (22%) suffered respiratory depression requiring higher level care (PACU, ICU), respiratory interventions (i.e. re-intubation), reversal agents, and adjustments in ordered pain medications.

CONCLUSIONS: LD experience significant pain after LD according to their subjective pain scores, despite extensive multifaceted pain regimens. Most pain is experienced as IV drugs are switched to PO regimen. Despite close monitoring a significant portion of patients experience sequelae of over narcotization, presenting significant patient safety risk to LD. Pain management in LD needs to be improved to safely provide better pain control.

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