{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T03:27:25Z","timestamp":1762918045131,"version":"build-2065373602"},"reference-count":28,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2019,10,7]],"date-time":"2019-10-07T00:00:00Z","timestamp":1570406400000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec><jats:title>Study Objective<\/jats:title><jats:p>Nonopioid strategies to optimize pain management in patients after liver transplantation remain underexplored. The purpose of this study was to evaluate whether the use of a multimodal pain management (<jats:styled-content style=\"fixed-case\">MPM<\/jats:styled-content>) order set would reduce postoperative opioid use in adult patients after liver transplantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective pre\u2013 and post\u2013order set implementation study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Large academic tertiary care hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>Thirty\u2010one adults who underwent liver transplantation were included; of these, 18 received provider\u2010managed pain regimens (pre\u2010<jats:styled-content style=\"fixed-case\">MPM<\/jats:styled-content> group: August 20, 2016\u2013January 17, 2018), and 13 received the <jats:styled-content style=\"fixed-case\">MPM<\/jats:styled-content> order set (post\u2010<jats:styled-content style=\"fixed-case\">MPM<\/jats:styled-content> group: January 18\u2013July 31, 2018) after implementation of the order set on January 18, 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements and Main Results<\/jats:title><jats:p>The <jats:styled-content style=\"fixed-case\">MPM<\/jats:styled-content> order set included standardized receipt of acetaminophen 650\u00a0mg every 6\u00a0hours, gabapentin 300\u00a0mg every 8\u00a0hours (adjusted for renal function), and opioids for breakthrough pain. Patients managed with the <jats:styled-content style=\"fixed-case\">MPM<\/jats:styled-content> order set received, on average, 30.6 fewer opioid morphine milligram equivalents per day after final extubation than patients who did not receive <jats:styled-content style=\"fixed-case\">MPM<\/jats:styled-content> (median 16, interquartile range [<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content>] 4.5\u201345.6 vs median 46.6, IQR 30.1\u201375.2; Mann\u2010Whitney <jats:italic>U<\/jats:italic> test, p=0.031). Although patients in the post\u2010<jats:styled-content style=\"fixed-case\">MPM<\/jats:styled-content> group had significantly worse renal function at baseline, no other statistically significant differences in baseline characteristics, pain scores, or prescribed outpatient opioids were noted between groups. Patients in the pre\u2010<jats:styled-content style=\"fixed-case\">MPM<\/jats:styled-content> group had a shorter intensive care unit and overall length of stay; however, patients in the post\u2010<jats:styled-content style=\"fixed-case\">MPM<\/jats:styled-content> group may have had more complex postoperative courses contributing to these differences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Implementation of the <jats:styled-content style=\"fixed-case\">MPM<\/jats:styled-content> order set significantly reduced postoperative opioid use in liver transplant recipients. Our results provide a compelling rationale to further investigate the use of a non\u2013opioid\u2010centered strategy to optimize pain management in patients recovering from liver transplantation, a population vulnerable to the risks of opioid use such as opioid use disorder, increased susceptibility to adverse effects, and poor allograft and survival outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.2322","type":"journal-article","created":{"date-parts":[[2019,8,25]],"date-time":"2019-08-25T06:43:01Z","timestamp":1566715381000},"page":"975-982","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Implementation of a Multimodal Pain Management Order Set Reduces Perioperative Opioid Use after Liver Transplantation"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6861-0345","authenticated-orcid":false,"given":"Kimhouy","family":"Tong","sequence":"first","affiliation":[{"name":"Department of Pharmacy Services Hartford Hospital Hartford Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5436-617X","authenticated-orcid":false,"given":"William","family":"Nolan","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services Hartford Hospital Hartford Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3662-5358","authenticated-orcid":false,"given":"David M.","family":"O'Sullivan","sequence":"additional","affiliation":[{"name":"Department of Research Administration Hartford HealthCare Hartford Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Sheiner","sequence":"additional","affiliation":[{"name":"Department of Transplant Hartford Hospital Hartford Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0106-9822","authenticated-orcid":false,"given":"Heather L.","family":"Kutzler","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services Hartford Hospital Hartford Connecticut"},{"name":"Department of Transplant Hartford Hospital Hartford Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,10,7]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15276"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2002.10435.x"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2019.02.025"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2014.07.023"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.24714"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.12806"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2008.07.062"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.24731"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0952-8180(02)00390-2"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.13112"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2005.00438.x"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00590-013-1208-z"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2013.06.005"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2013.09.005"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1749-8090-9-52"},{"issue":"325","key":"e_1_2_6_17_1","first-page":"e1","article-title":"Decreasing postoperative narcotics in reconstructive pelvic surgery: a randomized controlled trial","volume":"217","author":"Reagan KML","year":"2017","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_6_18_1","unstructured":"FDA.Extended\u2010release (ER) and long\u2010acting (LA) opioid analgesics Risk Evaluation and Mitigation Strategy (REMS). 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