Opioid Reducing Pain Management in Adult Liver Transplant Recipients

Friday, October 24, 2025

8:00 AM - 9:15 AM MT

Location: Kiosk 9

Primary Author(s)

Richard Fagbemigun, MD MSc

Resident Physician
Johns Hopkins Hospital
Baltimore, Maryland
Richard Fagbemigun, MD MSc

Resident Physician
Johns Hopkins Hospital
Baltimore, Maryland

Co-Author(s)

RI

Rafaello Ibrado, MD

Resident Physician
University of Florida
Oak Lawn, Illinois
RI

Rafaello Ibrado, MD

Resident Physician
University of Florida
Oak Lawn, Illinois
PG

Puneet Gupta, MD

Resident
George Washington University School of Medicine & Health Sciences
Washington, District of Columbia
PG

Puneet Gupta, MD

Resident
George Washington University School of Medicine & Health Sciences
Washington, District of Columbia

Disclosure(s):

Richard Fagbemigun, MD MSc: No financial relationships to disclose

Rafaello Ibrado, MD: No financial relationships to disclose

Background and/or Objectives: Liver transplant recipients have complex perioperative pain management needs due to altered pharmacokinetics and comorbidities. Opioid-based pain control poses risks such as dependency, adverse effects, and potential impact on graft survival. Alternative pain management strategies are being explored, including regional anesthesia and multimodal analgesia.

Design: Review of existing literature on opioid-reducing pain management strategies in liver transplant recipients.

Setting : N/A

Participants : Liver transplant patients

Interventions: Comparison of regional anesthesia techniques: thoracic epidural analgesia (TEA), transversus abdominis plane (TAP) block, and erector spinae plane (ESP) block. Analysis of alternative pain management approaches, including non-opioid medications and adjunct therapies (e.g., pregabalin, lidocaine infusion, massage therapy).

Main Outcome Measures: Pain control

Results: For regional anesthesia, TEA offers effective pain control but presents concerns over coagulopathy risks. TAP blocks have been found to reduce opioid consumption without significantly altering pain scores. Meanwhile, the Erector Spinae Plane (ESP) Block is emerging as a safe alternative, though it necessitates further study for validation. For non-conventional pain management, preoperative pregabalin reduced opioid consumption by nearly 70%. Lidocaine infusions show promise but require additional validation. Adjunct therapies (hand/back massage) demonstrated reductions in pain and anxiety.

Conclusions: Effective pain control is essential for recovery, reducing hospital stay, and preventing complications. Multimodal, opioid-reducing strategies improve patient outcomes and reduce opioid-related risks. Further large-scale, randomized trials are needed to determine the most effective pain management protocols.