**3.7 Pain management**

Orthotopic liver transplant patients were reported to experience less pain and use less morphine in the postoperative period compared to liver resection patients (Moretti et al, 2002). Chen et al have found morphine consumption significantly lower in patients with end-stage liver disease undergoing living-donor liver transplantation; compared with healthy living liver donors and patients with liver cirrhosis due to chronic hepatitis B or C virus infection and hepatocellular carcinoma undergoing hepatectomy, only on the first postoperative day (Chen et al, 2010).

Epidural anesthesia and analgesia provide a good quality of pain relief after major surgery. Cosidering the well known coagulation disorders associated with liver surgery, epidural hematoma formation is a major risk. Nowadays, although it seems that epidural analgesia for living liver donor is a safe method for analgesia, it may be hazardous for recipients because of unpredictable coagulopathies after liver transplantation (Lukanovic et al, 2008).

The type of surgical incision, in particular upper midline compared with subcostal incision affects postoperative pain, but the safety and efficacy needs to be further evaluated (Kim et al, 2009).
