Analgesia for Chronic Liver Disease Patients - Which one do you prefer?

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Permalink Reply by Mohinder vindhyal on July 6, 2009 at 7:21am

opiods
just read the journal

http://www.jhu.edu/~jhumag/0699web/pain.html

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Permalink Reply by dr t. rajesh patnaik on July 6, 2009 at 5:17pm

i go for tramadol ...opoid analgesics.......even the same for patients with renal problem

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Permalink Reply by Doctors Hangout Team on July 6, 2009 at 6:09pm

I do agree that opioid's are the best analgesics available on earth, but they frequently produce mental status changes. They may exacerbate underlying mental status changes. These patients are under high risk for progression into hepatic encephalopathy. Opioid's cause constipation which in turn lead to more gut protein load and so high risk for hepatic encephalopathy.

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Permalink Reply by Dr. Chaitali on July 6, 2009 at 11:18pm

a powerful NSAID would be preffered in this case because it mite affect the live less than wht para n opiods might ...!!!i think so...not sure though.....

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Permalink Reply by Doctors Hangout Team on July 7, 2009 at 12:38am

NSAID's cause GI mucosal injury and hence GI bleed which may worsen Hepatic Encephalopathy. NSAID's cause fluid retention which may worsen systemic hypertension and probably portal hypertension too. You should monitor serum creatinine also.

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Permalink Reply by Abdul Rasheed on July 8, 2009 at 4:40am

paracetemol- is metabolised in the liver. so it is not given when liver is compromised.
NSAIDS- cause bleeding. in the liver dysfunction synthesis of coagulation factors is adversely affected. so gi bleeding may cause anemia.

so OPIODS are the best choice....... subjected to challenge

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Permalink Reply by Jennie Hogan on January 10, 2010 at 3:19am

Ascites due to portal hypertension? varices likely, NSAIDS can lead to bleed so risks out weigh any benefits of treatment. Some opioids ok as long as patient does not become constipated which can precipitate encephalopathy. Ascites can reduce oral absorption. Start at low doses and monitor for side effects. Avoid tramadol and pethidine as they lower seizure threshold. Even in Liver disease paracetamol is only hepatotoxic in overdose. Dose interval may need to be prolonged if prothrombin time is increased. Paracetamol is the best choice,

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Permalink Reply by amjad ali on January 11, 2010 at 12:38am

paracetamol is the safest analgesia in CLD patients in usual analgesics doses.
if it wl nt cntrl pain yhen we should go 4 opiods.
link- Am J Ther. 2005 Mar-Apr;12(2):133-41.

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Permalink Reply by Dr. R. Narayanan on January 13, 2010 at 5:43pm

Opioids like tramadol which is less likely to cause constipation. Even if it occurs, can always be treated symptomatically. Tramadol causes minimal CNS changes and not exacerbating or increasing the chances of encephalopathy.

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Permalink Reply by Dr. R. Narayanan on January 13, 2010 at 5:45pm

But in analgesic doses, if there is no severe elevation of liver enzymes, paracetamol can always be added if required to the milder opioids.

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Permalink Reply by dr.v.k.agarwal on February 9, 2010 at 6:23pm

paracetamol or may be opioids
but no way
nasaid(hemorrhage)
and best ,safer is acupuncture and meditation,i so believe

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Permalink Reply by Dr.Manohar Joshi on February 9, 2010 at 10:35pm

Only opioids can be given in alcoholic cirrhosis
Otherwise paracetamol or NSAID's are not to be give as they metabolized in liver n they can worsen the disease as these drug can them self causes liver toxicity.....so they are absolutly contraindicated in any type of liver cell failure.
As cirrhosis is the final stage of liver cell failure.....if we add these drug then it can increase the complication.

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