Abstract

Research Article

Effects of intraoperative epidural anesthesia during hepatectomy on intraoperative and post-operative patient outcomes

Annette Rebel*, Christopher Mallard, Brad Withers, Brooke Bauer, Paul A Sloan, Sean Dineen and Annette Rebel*

Published: 13 November, 2018 | Volume 2 - Issue 1 | Pages: 023-030

Objective: The objective of this study was to evaluate the effects of intraoperative epidural anesthesia combined with balanced general anesthesia on intraoperative hemodynamics and fluid requirement, and on postoperative patient outcome.

Design: The study design was a retrospective data analysis of patients undergoing open hepatectomy at a single tertiary care center from May, 2013 to June, 2016. Patients undergoing hepatectomies were separated into two groups: patients not receiving epidural local anesthetic intraoperatively (either no epidural or epidural catheter not used intraoperatively) were designated the control group and patients receiving epidural local anesthetic intraoperatively (bolus and/or continuously). Patients were excluded if they underwent laparoscopic or non-elective procedures.

Results: 103 patients were included in the data analysis: Control n=14, Epidural = 89 patients. There were no major differences in demographics between groups. Epidural patients did not have higher requirements in intraoperative intravenous fluid administration, blood loss, or vasopressor use compared to control patients. Patients who received epidurals required less intravenous opioids with better post-operative pain scores initially and also on post-operative day 2. There were no differences in length of time to ambulation, or post-operative acute kidney injury amongst groups.

Conclusions: This study shows that patients undergoing hepatectomies using combined epidural and general anesthesia: 1) have no increased requirement for intraoperative crystalloid, colloid, or blood component therapy, 2) require lower total intravenous opioid dose, and 3) subjectively report better pain control. Therefore, intraoperative epidural anesthesia combined with general anesthesia may be advantageous for ERAS protocol based oncological procedures.

Read Full Article HTML DOI: 10.29328/journal.ijcar.1001008 Cite this Article Read Full Article PDF

Keywords:

Enhanced recovery after surgery; Hepatectomy; Analgesia; Epidural; Neoplasms; Opioid sparing analgesia; Vasopressor

References

  1. Siniscalchi A, Gamberini L, Bardi T, Laici C, Gamberini E, et al. Role of epidural anesthesia in a fast track liver resection protocol for cirrhotic patients - results after three years of practice. World J Hepatol. 2016; 8: 1097-1104. Ref.: https://goo.gl/HWzZSG
  2. Allen S, DeRoche A, Adams L, Slocum KV, Clark CJ, et al. Effect of epidural compared to patient-controlled intravenous analgesia on outcomes for patients undergoing liver resection for neoplastic disease. J Surg Oncol. 2017; 115: 402-406. Ref.: https://goo.gl/JE14wk
  3. Tzimas P, Prout J, Papadopoulos G, Mallett SV. Epidural anaesthesia and analgesia for liver resection. Anaesthesia. 2013; 68: 628-635. Ref.: https://goo.gl/3mB1y7
  4. Elterman KG, Xiong Z. Coagulation profile changes and safety of epidural analgesia after hepatectomy: a retrospective study. J Anesth. 2015; 29: 367-372. Ref.: https://goo.gl/5r9McC
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  6. McAuley D. Global Rph Opioid analgesic converter. Ref.: https://goo.gl/mRWPxr
  7. Schreiber KL, Chelly JE, Lang RS, Abuelkasem E, Geller DA, et al. Epidural Versus Paravertebral Nerve Block for Postoperative Analgesia in Patients Undergoing Open Liver Resection: A Randomized Clinical Trial. Reg Anesth Pain Med. 2016; 41: 460-468. Ref.: https://goo.gl/smiHux
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