Evidence-based Postoperative Analgesic Treatment for Femur Fracture Patient with Liver Cirrhosis_West China Medical Journal

Authors：

 CHENYu , NIULei ,  ZHOUZong-ke

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZHOUZong-ke, Email: zongke@126.com

Keywords：

Postoperative analgesia; Liver cirrhosis; Analgesics; Adverse effect; Evidence-based treatment

DOI：

10.7507/1002-0179.20150005

Video：

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Objective To provide references for postoperative analgesia treatment for cirrhotic patients with bone fracture. Methods One elderly patient with liver cirrhosis and fracture was admitted to our hospital on July 9, 2013. We obtained medical evidences by searching databases and regulated the best treatment after evaluating the patient's comprehensive conditions. And then, the whole treatment strategy was fully implemented. Finally, the consequent results were evaluated. Results We identified 22 relevant articles including one clinical guideline, three cochrane reviews, five systematic reviews, seven small sample randomized controlled trials, one high quality observational study, and five quantitative reviews. We found that opioid analgesics utilization combined with non-opioid analgesics could not only reduce the occurrence of opioid drug adverse reactions, but increase analgesia safety. Cox-2 inhibitors could be used as the first choice of non-opioid drugs due to the less adverse reaction and better analgesic effectiveness. Conclusion For femur fracture patients with liver cirrhosis, treatment decision based on evidence-based medicine is more scientific, which can ensure maximum benefit for the patients.

Citation： CHENYu, NIULei, ZHOUZong-ke. Evidence-based Postoperative Analgesic Treatment for Femur Fracture Patient with Liver Cirrhosis. West China Medical Journal, 2015, 30(1): 22-25. doi: 10.7507/1002-0179.20150005 Copy

1.	Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit[J]. Crit Care Med, 2013, 41(1):263-306.
2.	Derry S, Moore RA. Single dose oral aspirin for acute postoperative pain in adults[J]. Cochrane Database Syst Rev, 2012(4):CD002067.
3.	Moore RA, Derry S, Mcquay HJ, et al. Single dose oral analgesics for acute postoperative pain in adults[J]. Cochrane Database Syst Rev, 2011(9):CD008659.
4.	Radner H, Ramiro S, Buchbinder R. Pain management for inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and other spondylarthritis) and gastrointestinal or liver comorbidity[J]. Cochrane Database Syst Rev, 2012(1):CD008951.
5.	Barden J, Edwards JE, Mcquay HJ, et al. Oral valdecoxib and injected parecoxib for acute postoperative pain:a quantitative systematic review[J]. BMC Anesthesiol, 2003, 3(1):1-9.
6.	Montané E, Vallano A, Aguilera C, et al. Analgesics for pain after traumatic or orthopaedic surgery:what is the evidence--a systematic review[J]. Eur J Clin Pharmacol, 2006, 62(11):971-988.
7.	Essex MN, Zhang RY, Berger M, et al. Safety of celecoxib compared with placebo and non-selective NSAIDs:cumulative meta-analysis of 89 randomized controlled trials[J]. Expert Opin Drug Saf, 2013, 12(4):465-477.
8.	Mason L, Edwards JE, Moore RA, et al. Single-dose oral naproxen for acute postoperative pain:a quantitative systematic review[J]. BMC Anesthesiol, 2003, 3(1):4.
9.	Oxford Centre for Evidence-based Medicine. Oxford Centre for Evidence-based Medicine-levels for evidence (March 2009)[EB/OL].[2014-09-03]. http:www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009.
10.	Balshem H, Helfanda M, Schunemann HJ, et al. GRADE guideline:3. rating the quality of evidence[J]. J Clin Epidemiol, 2011, 64(4):401-406.
11.	Faura CC, Collins SL, Moore RA, et al. Systematic review of factors affecting the ratios of morphine and its major metabolites[J]. Pain, 1998, 74(1):43-53.
12.	Taurá P, Fuster J, Blasi A, et al. Postoperative pain relief after hepatic resection in cirrhotic patients:the efficacy of a single small dose of ketamine plus morphine epidurally[J]. Anesth Analg, 2003, 96(2):475-480.
13.	Yassen AM, Sayed GE. Low dose ketorolac infusion improves postoperative analgesia combined with patient controlled fentanyl analgesia after living donor hepatectomy-randomized controlled trial[J]. Egyptian J Anaesth, 2012, 28(3):199-204.
14.	Lee SH, Gwak MS, Choi SJ, et al. Prospective, randomized study of ropivacaine wound infusion versus intrathecal morphine with intravenous fentanyl for analgesia in living donors for liver transplantation[J]. Liver Transplant, 2013, 19(9):1036-1045.
15.	Deng GF, Zheng JP, Wang S, et al. Remifentanil combined with low-dose ketamine for postoperative analgesia of lower limb fracture:a double-blind, controlled study[J]. Chin J of Traumatol, 2009, 12(4):223-227.
16.	Segado Jiménez MI, Bayón Gago M, Arias Delgado J, et al. Efficacy of obturator and femoral cutaneous nerve blocks for postoperative analgesia in hip surgery[J]. Rev Esp Anestesiol Reanim, 2009, 56(10):590-597.
17.	Machino M, Yukawa Y, Hida T, et al. A prospective randomized study for postoperative pain relief of lower extremity fractures:efficacy of intrathecal morphine administration[J]. Nagoya J Med Sci, 2010, 72(3/4):145-150.
18.	Siddiqui AK, Sadat-Ali M, Al-Ghamdi AA. The effect of etoricoxib premedication on postoperative analgesia requirement in orthopedic and trauma patients[J]. Saudi Med J, 2008, 29(7):966-970.
19.	Chen P, Jawan B, Chen CL, et al. Comparison of postoperative morphine requirements in healthy living liver donors, patients with hepatocellular carcinoma undergoing partial hepatectomy, and liver transplant recipients[J]. Transplant Proc, 2010, 42(3):701-702.
20.	Wiebalck CA, van Aken H. Paracetamol and propacetamol for post-operative pain:contrasts to traditional NSAIDs[J]. Baillière's Clin Anaesthesiol, 1995, 9(3):469-482.
21.	Andersen G, Christrup L, Sjgren P. Relationships among morphine metabolism, pain and side effects during long-term treatment:an update[J]. J Pain Symptom Manage, 2003, 25(1):74-91.
22.	Chohan AS. Anesthetic considerations in orthopedic patients with or without trauma[J]. Top Companion Anim Med, 2010, 25(2):107-119.
23.	Schug SA, Manopas A. Update on the role of non-opioids for postoperative pain treatment[J]. Best Pract Res Clin Anaesthesiol, 2007, 21(1):15-30.
24.	Chandok N, Watt KD. Pain management in the cirrhotic patient:the clinical challenge[J]. Mayo Clin Proc, 2010, 85(5):451-458.

1. Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit[J]. Crit Care Med, 2013, 41(1):263-306.
2. Derry S, Moore RA. Single dose oral aspirin for acute postoperative pain in adults[J]. Cochrane Database Syst Rev, 2012(4):CD002067.
3. Moore RA, Derry S, Mcquay HJ, et al. Single dose oral analgesics for acute postoperative pain in adults[J]. Cochrane Database Syst Rev, 2011(9):CD008659.
4. Radner H, Ramiro S, Buchbinder R. Pain management for inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and other spondylarthritis) and gastrointestinal or liver comorbidity[J]. Cochrane Database Syst Rev, 2012(1):CD008951.
5. Barden J, Edwards JE, Mcquay HJ, et al. Oral valdecoxib and injected parecoxib for acute postoperative pain:a quantitative systematic review[J]. BMC Anesthesiol, 2003, 3(1):1-9.
6. Montané E, Vallano A, Aguilera C, et al. Analgesics for pain after traumatic or orthopaedic surgery:what is the evidence--a systematic review[J]. Eur J Clin Pharmacol, 2006, 62(11):971-988.
7. Essex MN, Zhang RY, Berger M, et al. Safety of celecoxib compared with placebo and non-selective NSAIDs:cumulative meta-analysis of 89 randomized controlled trials[J]. Expert Opin Drug Saf, 2013, 12(4):465-477.
8. Mason L, Edwards JE, Moore RA, et al. Single-dose oral naproxen for acute postoperative pain:a quantitative systematic review[J]. BMC Anesthesiol, 2003, 3(1):4.
9. Oxford Centre for Evidence-based Medicine. Oxford Centre for Evidence-based Medicine-levels for evidence (March 2009)[EB/OL].[2014-09-03]. http:www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009.
10. Balshem H, Helfanda M, Schunemann HJ, et al. GRADE guideline:3. rating the quality of evidence[J]. J Clin Epidemiol, 2011, 64(4):401-406.
11. Faura CC, Collins SL, Moore RA, et al. Systematic review of factors affecting the ratios of morphine and its major metabolites[J]. Pain, 1998, 74(1):43-53.
12. Taurá P, Fuster J, Blasi A, et al. Postoperative pain relief after hepatic resection in cirrhotic patients:the efficacy of a single small dose of ketamine plus morphine epidurally[J]. Anesth Analg, 2003, 96(2):475-480.
13. Yassen AM, Sayed GE. Low dose ketorolac infusion improves postoperative analgesia combined with patient controlled fentanyl analgesia after living donor hepatectomy-randomized controlled trial[J]. Egyptian J Anaesth, 2012, 28(3):199-204.
14. Lee SH, Gwak MS, Choi SJ, et al. Prospective, randomized study of ropivacaine wound infusion versus intrathecal morphine with intravenous fentanyl for analgesia in living donors for liver transplantation[J]. Liver Transplant, 2013, 19(9):1036-1045.
15. Deng GF, Zheng JP, Wang S, et al. Remifentanil combined with low-dose ketamine for postoperative analgesia of lower limb fracture:a double-blind, controlled study[J]. Chin J of Traumatol, 2009, 12(4):223-227.
16. Segado Jiménez MI, Bayón Gago M, Arias Delgado J, et al. Efficacy of obturator and femoral cutaneous nerve blocks for postoperative analgesia in hip surgery[J]. Rev Esp Anestesiol Reanim, 2009, 56(10):590-597.
17. Machino M, Yukawa Y, Hida T, et al. A prospective randomized study for postoperative pain relief of lower extremity fractures:efficacy of intrathecal morphine administration[J]. Nagoya J Med Sci, 2010, 72(3/4):145-150.
18. Siddiqui AK, Sadat-Ali M, Al-Ghamdi AA. The effect of etoricoxib premedication on postoperative analgesia requirement in orthopedic and trauma patients[J]. Saudi Med J, 2008, 29(7):966-970.
19. Chen P, Jawan B, Chen CL, et al. Comparison of postoperative morphine requirements in healthy living liver donors, patients with hepatocellular carcinoma undergoing partial hepatectomy, and liver transplant recipients[J]. Transplant Proc, 2010, 42(3):701-702.
20. Wiebalck CA, van Aken H. Paracetamol and propacetamol for post-operative pain:contrasts to traditional NSAIDs[J]. Baillière's Clin Anaesthesiol, 1995, 9(3):469-482.
21. Andersen G, Christrup L, Sjgren P. Relationships among morphine metabolism, pain and side effects during long-term treatment:an update[J]. J Pain Symptom Manage, 2003, 25(1):74-91.
22. Chohan AS. Anesthetic considerations in orthopedic patients with or without trauma[J]. Top Companion Anim Med, 2010, 25(2):107-119.
23. Schug SA, Manopas A. Update on the role of non-opioids for postoperative pain treatment[J]. Best Pract Res Clin Anaesthesiol, 2007, 21(1):15-30.
24. Chandok N, Watt KD. Pain management in the cirrhotic patient:the clinical challenge[J]. Mayo Clin Proc, 2010, 85(5):451-458.

West China Medical Journal

Evidence-based Postoperative Analgesic Treatment for Femur Fracture Patient with Liver Cirrhosis

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