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

A 43 yrs male who is a known case of Alcoholic Cirrhosis presented to you with left leg fracture, mild jaundice and tense ascites. Patient is in severe pain. Which analgesic do you prefer and why?

Paracetamol?
Powerful NSAID's?
Opioid's?

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Replies to This Discussion

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; ▶ Reply to This

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; ▶ Reply to This

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.; ▶ Reply to This

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.....; ▶ Reply to This

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.; ▶ Reply to This

Permalink Reply by somesh on July 7, 2009 at 7:41am: Paracetamol is the drug of choice,, opiods are mostly used in severe,non localised internal visceral pain.
NSAIDS are used in sharp localised pain,,powerfull NSAIDs has adverse effects like Peptic ulceration, aggravate bronchial asthama,,cause dysmennorhea ,, has a blood thinning effect,, liver damage too, but Paracetamol has strong antipyretic and weak anti inflammatory action,, and only few ADR when compared to other NSAIDs. I prefer combination of drugs like PARACETAMOL+OPIODS like PETHIDINE.; ▶ Reply to This

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; ▶ Reply to This