*Purpose: The study aimed to determine if multi-modal pain management (MPM) can reduce opioid use in patients post-liver transplant.

*Methods: This was a retrospective review of liver transplant recipients from 8/20/2016 to 7/31/2018. Of 44 cases screened for inclusion, 11 were excluded for simultaneous liver-kidney transplant, pharmacy pain consult, or intra-operative death. Twenty patients were admitted prior to MPM launch on 1/18/2018 and received provider-guided pain management, while 13 patients were admitted after MPM launch and received scheduled acetaminophen 650 mg every 6 hours and gabapentin 300 mg every 8 hours (renally adjusted) with opioids only for breakthrough pain. Categorical binomial data were analyzed using the Chi-squared or Fisher’s test. Continuous data were compared using Mann-Whitney U or Student’s t-test. All tests of statistical significance set α=0.05.

*Results: Pre- and post-MPM patients had no statistically significant differences in baseline characteristics. Post-MPM patients received 47.25 fewer morphine milligram equivalents (MMEs) per day than pre-MPM patients (median; IQR 22.5; 6.93- 47.91 versus 69.75; 39.66-129.58, respectively, p=0.010). Pre-MPM patients had a shorter overall length of stay (LOS) (7.2 ± 2.3 versus 10.4 ± 4.7 days respectively, p=0.038) and ICU LOS relative to post-MPM patients (3.2 ± 2.0 versus 4.8 ± 2.6 days, p=0.0498). However, the post-MPM group may have had more complex clinical courses, supported by a trend towards longer time to final extubation. There was no statistical difference between pre- and post-MPM average MMEs prescribed outpatient (median; IQR 22.04; 10.00-46.88 versus 25.00; 0-49.17, respectively).

*Conclusions: Use of MPM significantly reduced opioid use after liver transplant. Our results provide a compelling rationale to further investigate the use of a non-opioid centered strategy to optimize pain management in this population.

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