Can adequate analgesia be achieved in patients with cirrhosis without precipitating hepatic encephalopathy? A prospective study

Ashley Bloom; Vanessa Weerasinghe Mudiyansalage; Anna Rhodes; Malcolm Hogg; Chatura Jayasekera; Alexandra Gorelik; Siddharth Sood; Amanda Nicoll

doi:10.5114/ceh.2020.99521

eISSN: 2449-8238
ISSN: 2392-1099

Clinical and Experimental Hepatology

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abstract:

Original paper

Can adequate analgesia be achieved in patients with cirrhosis without precipitating hepatic encephalopathy? A prospective study

Ashley Bloom

¹

,

Vanessa Weerasinghe Mudiyansalage

²

,

Anna Rhodes

²

,

Malcolm Hogg

³

,

Chatura Jayasekera

²

,

Alexandra Gorelik

⁴

,

Siddharth Sood

^{2, 5}

,

Amanda Nicoll

^{1, 2}

Department of Gastroenterology, Eastern Health, Australia
Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Australia
Department of Analgesia and Pain Management, Royal Melbourne Hospital, Australia
Melbourne EpiCentre, Royal Melbourne Hospital, Australia
Department of Medicine, Royal Melbourne Hospital, Australia

Clin Exp HEPATOL 2020; 6, 3: 243–252

DOI: https://doi.org/10.5114/ceh.2020.99521

Online publish date: 2020/09/30

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AMA

Bloom A, Weerasinghe Mudiyansalage V, Rhodes A, et al. Can adequate analgesia be achieved in patients with cirrhosis without precipitating hepatic encephalopathy? A prospective study. Clinical and Experimental Hepatology. 2020;6(3):243-252. doi:10.5114/ceh.2020.99521.

APA

Bloom, A., Weerasinghe Mudiyansalage, V., Rhodes, A., Hogg, M., Jayasekera, C.,  & Gorelik, A. et al. (2020). Can adequate analgesia be achieved in patients with cirrhosis without precipitating hepatic encephalopathy? A prospective study. Clinical and Experimental Hepatology, 6(3), 243-252. https://doi.org/10.5114/ceh.2020.99521

Chicago

Bloom, Ashley, Vanessa Weerasinghe Mudiyansalage, Anna Rhodes, Malcolm Hogg, Chatura Jayasekera, Alexandra Gorelik,  and Siddharth Sood et al. 2020. "Can adequate analgesia be achieved in patients with cirrhosis without precipitating hepatic encephalopathy? A prospective study". Clinical and Experimental Hepatology 6 (3): 243-252. doi:10.5114/ceh.2020.99521.

Harvard

Bloom, A., Weerasinghe Mudiyansalage, V., Rhodes, A., Hogg, M., Jayasekera, C., Gorelik, A., Sood, S.,  and Nicoll, A. (2020). Can adequate analgesia be achieved in patients with cirrhosis without precipitating hepatic encephalopathy? A prospective study. Clinical and Experimental Hepatology, 6(3), pp.243-252. https://doi.org/10.5114/ceh.2020.99521

MLA

Bloom, Ashley et al. "Can adequate analgesia be achieved in patients with cirrhosis without precipitating hepatic encephalopathy? A prospective study." Clinical and Experimental Hepatology, vol. 6, no. 3, 2020, pp. 243-252. doi:10.5114/ceh.2020.99521.

Vancouver

Bloom A, Weerasinghe Mudiyansalage V, Rhodes A, Hogg M, Jayasekera C, Gorelik A et al. Can adequate analgesia be achieved in patients with cirrhosis without precipitating hepatic encephalopathy? A prospective study. Clinical and Experimental Hepatology. 2020;6(3):243-252. doi:10.5114/ceh.2020.99521.

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Introduction
Analgesic use in patients with liver cirrhosis can be associated with increased morbidity and mortality and presents clinicians with a significant and challenging management issue. We evaluated the efficacy of opiate analgesia in patients with cirrhosis, while closely monitoring the side effect profile.

Material and methods
This prospective cohort pilot study compared inpatients with cirrhosis who required regular opiate analgesia to non-cirrhotic patients requiring opiates and patients with cirrhosis who did not require opiates. Participants completed daily surveys to assess for analgesic efficacy and encephalopathy.

Results
Fifty-two patients were initially recruited, of whom 50 patients were analysed in three groups (40 male, 10 female, median age 52 years). These included 13 cirrhotic patients (69% Child-Pugh B or C) requiring regular opiate analgesia, 18 cirrhotic patients (67% Child-Pugh B or C) not receiving regular opiate analgesia, and 19 non-cirrhotic controls. Two patients were excluded due to past stroke and acquired brain injury. All cirrhotic patients received regular lactulose. There was no statistical difference in the adequacy of analgesia between the three groups. The modified orientation log score for encephalopathy remained in the normal range in all but two cirrhotic patients receiving regular opiate analgesia.

Conclusions
Effective pain control is achievable with opiate analgesia in most patients with advanced liver disease without precipitating hepatic encephalopathy.

keywords:

Can adequate analgesia be achieved in patients with cirrhosis without precipitating hepatic encephalopathy? A prospective study

Ashley Bloom 1 , Vanessa Weerasinghe Mudiyansalage 2 , Anna Rhodes 2 , Malcolm Hogg 3 , Chatura Jayasekera 2 , Alexandra Gorelik 4 , Siddharth Sood 2, 5 , Amanda Nicoll 1, 2

liver disease, sedation, modified orientation log, pain, Brief Pain Inventory

Ashley Bloom

¹

,

Vanessa Weerasinghe Mudiyansalage

²

,

Anna Rhodes

²

,

Malcolm Hogg

³

,

Chatura Jayasekera

²

,

Alexandra Gorelik

⁴

,

Siddharth Sood

^{2, 5}

,

Amanda Nicoll

^{1, 2}