Impact of Opioids and Paracetamol after Liver Resection for Colorectal Cancer Metastasis

Author(s): Emil Östrand, Maja Bergfelt, Jenny Rystedt, Bodil Andersson, Bobby Tingstedt

Background: Altered metabolism after liver surgery adds complexity to postoperative pain management. Opioids administered via intravenous Patient Controlled Analgesia (PCA) is one of the main alternatives for initial pain management. Paracetamol is considered potentially dangerous after liver surgery but used selectively. This study evaluates whether there is a difference in patient outcome after hepatic resection, based on the amounts of opioids used in the first postoperative period, and on the use of postoperative paracetamol.

Methods: 208 consecutive patients with hepatic resection for colorectal liver metastasis in Lund, Sweden, were included. Opioids consumed within the first 24 hours postoperatively were summed up. The use of paracetamol in the first four days was recorded. The effect of opioid consumption was analysed by grouping patients into those consuming higher amounts of opioids than the median (HO) and those consuming less amounts (LO). Patient outcome was evaluated by length-of-stay (LOS) and postoperative complications.

Results: The HO-group had a longer LOS than the LO-group, by a regression coefficient of 1.19, p=0.001, after adjusting for confounders. Use of paracetamol individually shortened the LOS, by 0.83, p=0.002. There was no impact of these factors on postoperative complications.

Conclusion: Larger consumption of opioids in the first postoperative day negatively impacts the LOS. Paracetamol shortens the LOS and should be considered after hepatic surgery.

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