An overview of unresolved issues in the perioperative management of liver transplant patients.

Over the past decade, the field of solid organ transplantation has undergone significant changes, with some of the most notable advancements occurring in liver transplantation. Recent years have seen substantial progress in preoperative patient optimization protocols, anesthesia monitoring, coagulation management, and fluid management, among other areas. These improvements have led to excellent perioperative outcomes for all surgical patients, including those undergoing liver transplantation. In the last few decades, there have been numerous publications in the field of liver transplantation, but controversies related to perioperative management of liver transplant recipients persist. In this review article, we address the unresolved issues surrounding the anesthetic management of patients scheduled for liver transplantation.

Role of Intrathecal Morphine for Acute Postoperative Pain Management in Patients Undergoing Kidney Transplant: A Randomized Controlled Study.

OBJECTIVES: Postoperative pain after a major surgery continues to be a challenge. Regional anesthetic techniques make up a substantial part of interventions to decrease postoperative pain and the use of opioids. In this study, we aimed to evaluate the effectiveness of intrathecal morphine in patients undergoing kidney transplant, in terms of both duration and quality of postoperative analgesia. MATERIALS AND METHODS: We conducted a prospective randomized double-blind study and analyzed 60 patients divided into 2 groups of 30 each who were scheduled for elective living-related (first-degree donor) kidney transplant. One group received intrathecal morphine, and the other group received intrathecal normal saline. We used the numeric rating scale to assess the postoperative pain score. We also recorded the postoperative consumption of fentanyl, time of first analgesia requirement, total rescue analgesia, catheter-related bladder discomfort, and related complications for 48 hours postoperatively. RESULTS: Patients in the intrathecal morphine group had significantly lower pain scores both at rest and while coughing and less consumption of total fentanyl (P < .05). When we compared patient groups, patients in the intrathecal morphine group had significantly lower total rescue analgesia (P < .05) and significantly lower catheter-related bladder discomfort but significantly higher pruritus (P = .01). CONCLUSIONS: Intrathecal morphine significantly reduces postoperative opioid consumption and can result in fewer incidences of catheter-related bladder discomfort.

Postoperative pain relief and functional outcomes after pre-emptive ultrasound-guided caudal analgesia in patients undergoing spinal laminectomy under general anaesthesia: Comparison between bupivacaine versus bupivacaine with morphine.

Background and Aims: Prevention of the start of the neural cascade may result in long-term advantages by the elimination of hypersensitivity produced by noxious stimulus. This study was designed to evaluate postoperative pain and long-term functional outcomes after pre-emptive ultrasound (US)-guided caudal analgesia in patients undergoing spinal laminectomy. Methods: A total of 90 consecutive patients, aged 20 to 60 years, of either sex, scheduled for elective spinal laminectomy under general anaesthesia were randomly allocated to two groups. Group M (n = 45) received 3 mg morphine + 0.25% bupivacaine (25 ml), whereas group B (n = 45) was administered 0.25% bupivacaine (25 ml) in caudal block. The primary outcome was to observe postoperative static and dynamic pain using the Verbal Numerical Rating Score (VNRS) for 24 h. The secondary outcome was to record functional outcomes using two questionnaires-Oswestry Disability Index (ODI) and Rolland Morris Disability Questionnaire (RMDQ) during the preoperative period, at 1 month and 3 months postoperatively. Results: The static and dynamic VNRS scores were significantly less in group M (P < 0.05). There was a statistically significant clinical improvement in RMDQ and ODI scores at all-time intervals between both groups (P < 0.05). A four-point difference in ODI during subsequent months represents a true change and the results of our study showed an outstanding improvement of 9-11 points at 1 and 3 months from the baseline. Conclusion: The use of caudal block with the US guidance in adults undergoing spine surgeries can bring new horizons in improving pain relief and long-term functional outcomes.