Randomized clinical trial of local infiltration plus patient-controlled opiate analgesia vs. epidural analgesia following liver resection surgery

Abstract

Objectives: Epidural analgesia is recommended for the provision of analgesia following major abdominal surgery. Continuous local anaesthetic wound infiltration may be an effective alternative. A prospective randomized trial was undertaken to compare these two methods following open liver resection. The primary outcome was length of time required to fulfil criteria for discharge from hospital.

Methods: Patients undergoing open liver resection were randomized to receive either epidural (EP group) or local anaesthetic wound infiltration plus patient-controlled opiate analgesia (WI group) for the first 2 days postoperatively. All other care followed a standardized enhanced recovery protocol. Time to fulfil discharge criteria, pain scores, physical activity measurements and complications were recorded.

Results: Between August 2009 and July 2010, 65 patients were randomized to EP (n = 32) or WI (n = 33). The mean time required to fulfil discharge criteria was 4.5 days (range: 2.5-63.5 days) in the WI group and 6.0 days (range: 3.0-42.5 days) in the EP group (P = 0.044). During the first 48 h following surgery, pain scores were significantly lower in the EP group both at rest and on movement. Resting pain scores within both groups were rated as mild (range: 0-3). There was no significant difference between the groups in time to first mobilization or overall complication rate (48.5% in the WI group vs. 58.1% in the EP group; P = 0.443).

Conclusions: Local anaesthetic wound infiltration combined with patient-controlled opiate analgesia reduces the length of time required to fulfil criteria for discharge from hospital compared with epidural analgesia following open liver resection. Epidural analgesia provides superior analgesia, but does not confer benefits in terms of faster mobilization or recovery.

Trial registration: ClinicalTrials.gov NCT01042054.

© 2012 International Hepato-Pancreato-Biliary Association.

Figures

Figure 1

Exclusion criteria

Figure 2

Enhanced recovery care plan followed by both groups following open liver resection

Figure 3

Criteria for discharge from hospital following open liver resection

Figure 4

Flow diagram illustrating patient enrolment. WC, wound catheter

Figure 5

Mean pain scores (a) at rest (P= 0.015) and (b) on movement (P= 0.022) following open liver resection, in patients randomized to either wound catheter patient-controlled i.v. opiate analgesia or epidural analgesia. PoD, postoperative day