Effectiveness of epidural analgesia following open liver resection

Abstract

Objectives: Epidural analgesia is often considered the reference standard for pain relief following major abdominal surgery; however, the provision of analgesia in the context of liver surgery raises unique challenges. This study investigated the effectiveness of analgesia and the postoperative course of patients who did or did not receive epidural analgesia following liver resection.

Methods: Data were collected retrospectively on 177 patients who underwent open liver resection between June 2007 and June 2009. Patients were divided into two groups consisting, respectively, of those who received epidural analgesia (Epidural group, n= 148) and those who did not (No-Epidural group, n= 29).

Results: In the Epidural group, 27 patients (18%) required i.v. opiate analgesia on the day of surgery (DoS) or the first postoperative day (POD1). The Epidural group received significantly more i.v. colloid solution on the DoS (median: 1500 ml vs. 750 ml, range: 0-12,000 ml vs. 0-3500 ml; P= 0.004) and POD1 (median: 0 ml vs. 0 ml, range: 0-5000 ml vs. 0-1000 ml; P= 0.018), and total fluid on the DoS and POD1 combined (median: 6522 ml vs. 5453 ml, range: 2150-21 300 ml vs. 2875-15,886 ml; P= 0.032).

Conclusions: Epidural analgesia provided inadequate postoperative pain relief in approximately 20% of liver resection patients and was associated with the administration of significantly greater volumes of i.v. colloid solution.

© 2011 International Hepato-Pancreato-Biliary Association.

Figures

Figure 1

Flow diagram demonstrating outcome following attempted epidural catheter insertion in patients undergoing liver resection

Figure 2

Adequacy of epidural analgesia in 155 patients following liver resection. OT, operating theatre; POD, postoperative day

Figure 3

Volume of i.v. fluids received following liver resection. (A) Colloid solution administered on the day of surgery (DoS) (P= 0.004). (B) Colloid solution administered on postoperative day 1 (POD1) (P= 0.018). (C) Total colloid and crystalloid solution administered on the DoS and POD1 (P= 0.032). IQR, interquartile range