Effects of two different techniques of postoperative analgesia management in liver transplant donors: a prospective, randomized, double-blind study.

Transplantation Proceedings 2015; 47(4): 1204-1206.

Aims
To compare liver transplant patients receiving intravenous (IV) morphine with patient-controlled analgesia (PCA) to those receiving epidural morphine during the early postoperative period.

Interventions
Patients were randomized to receive either IV morphine 5 mg, or epidural anaesthesia adding morphine 2 mg by epidural anaesthesia technique starting 15 minutes before the estimated time of completion of surgery.

Participants
40 patients aged 18-65 years who underwent right hepatectomy surgery

Outcomes
Outcomes measured were acute postoperative pain intensity, morphine consumption, and adverse effects.

Follow-up
24 hours

CET Conclusions
Unfortunately this paper contradicts itself on the primary outcome in both the abstract and the main results section. The authors declare that morphine consumption in the epidural group was higher than in the IV morphine group. Yet later on it is reported that epidural morphine was associated with decreased morphine consumption. The numbers in table 2 support a reduced morphine consumption with epidural than IV PCA alone, and a better pain score (Visual Analogue Scale). The epidural set-up entailed a reduced bolus, longer lock-out time and smaller 4-hour total dose than the IV PCA group however. There was no description of randomisation or the method of double-blinding by which patients and their nurse-assessors could not tell which form of analgesia they were receiving. Appropriate statistical tests were used.

Jadad score
3

Data analysis
Modified intention-to-treat analysis

Allocation concealment
Yes

Trial registration
None

Funding source
Not reported