Postoperative pain trajectories to identify risk of chronic postsurgical pain in living donors for liver transplantation

Objectives. - To assess pain trajectories in predicting risk of chronic postoperative pain (CPP) after liver resection for living donor transplantation. Study design. - Retrospective analysis of patients undergoing liver resection for living donor transplantation during 3 years. Patients and methods. - After recording perioperative data, patients presenting CPP at 3 months were separated from patients without postsurgical pain problem in order to build a pain trajectory for liver donor patients without CPP. Postoperative course of liver donors with CPP was then compared to that standard pain trajectory. Results. - Sixty-five patients (30 females, 35 males) were included. Epidural analgesia was used in 66%; others received autocontrolled analgesia by morphine. Severe acute pain was expressed by 11% and 37% at rest and movement respectively on the first day. Chronic pain involved six patients without any link with gender or type of analgesia. Analysis of pain trajectories shown that these patients presented either higher initial pain at day 1 or positive slopes with worsening of pain. Conclusion. - Acute postoperative pain is a risk factor of developing CPP. Identification of those people by pain trajectories can be useful to treat them early. (C) 2012 Published by Elsevier Masson SAS on behalf of the Societe francaise d'anesthesie et de reanimation (Sfar).