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Abstract Details
Can adequate analgesia be achieved in patients with cirrhosis without precipitating hepatic encephalopathy? A prospective study
Ashley Bloom1, Vanessa Weerasinghe Mudiyansalage2, Anna Rhodes2, Malcolm Hogg3, Chatura Jayasekera2, Alexandra Gorelik4, Siddharth Sood25, Amanda Nicoll12
Author information
1Department of Gastroenterology, Eastern Health, Australia.
2Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Australia.
3Department of Analgesia and Pain Management, Royal Melbourne Hospital, Australia.
4Melbourne EpiCentre, Royal Melbourne Hospital, Australia.
5Department of Medicine, Royal Melbourne Hospital, Australia.
Abstract
Aim of the study: Analgesic use in patients with liver cirrhosis can be associated with increased morbidity and mortality and presents clinicians with a significant and challenging management issue. We evaluated the efficacy of opiate analgesia in patients with cirrhosis, while closely monitoring the side effect profile.
Material and methods: This prospective cohort pilot study compared inpatients with cirrhosis who required regular opiate analgesia to non-cirrhotic patients requiring opiates and patients with cirrhosis who did not require opiates. Participants completed daily surveys to assess for analgesic efficacy and encephalopathy.
Results: Fifty-two patients were initially recruited, of whom 50 patients were analysed in three groups (40 male, 10 female, median age 52 years). These included 13 cirrhotic patients (69% Child-Pugh B or C) requiring regular opiate analgesia, 18 cirrhotic patients (67% Child-Pugh B or C) not receiving regular opiate analgesia, and 19 non-cirrhotic controls. Two patients were excluded due to past stroke and acquired brain injury. All cirrhotic patients received regular lactulose. There was no statistical difference in the adequacy of analgesia between the three groups. The modified orientation log score for encephalopathy remained in the normal range in all but two cirrhotic patients receiving regular opiate analgesia.
Conclusions: Effective pain control is achievable with opiate analgesia in most patients with advanced liver disease without precipitating hepatic encephalopathy.