Duration of the thoracic epidural catheter in a fast-track recovery protocol may decrease the length of stay after a major hepatectomy: a case control study
A Ntinas, D Kardassis, I Konstantinopoulos, P Kottos, A Manias, M Kyritsi, D Zilianiaki, D Vrochides, A Ntinas, D Kardassis, I Konstantinopoulos, P Kottos, A Manias, M Kyritsi, D Zilianiaki, D Vrochides
Abstract
Background: Fast-track recovery protocols are applied to major surgeries, including hepatectomies. The optimal duration of thoracic epidural catheter has not yet been defined.
Objective: To determine the ideal time to remove the epidural catheter after major hepatectomy.
Patients-methods: Forty-eight consecutive patients who underwent major hepatectomy over 4 years were studied. The data from laparoscopic hepatectomy were not included. Patients who underwent hepaticojejunostomy were included. A modified protocol of rapid postoperative recovery was implemented. In the first 24 patients, an epidural catheter was maintained for 4 days (group A), while in the next 24, the catheter was maintained for 2 days (group B). The length of hospital stay, time of functional recovery, and use of opioids and laxatives were recorded.
Results: There was no postoperative mortality. The average length of hospital stay was 6.92 ± 1.79 and 6.09 ± 2.08 days for groups A and B, respectively. The mean functional recovery was 5.46 ± 0.3 and 5.26 ± 0.91 days for groups A and B, respectively. However, in group B, more opioid analgesics by 50% and more laxatives by 17% were used.
Conclusions: After major hepatectomy, a reduction from 4 to 2 days' duration of the epidural catheter may lead to a reduction in the length of hospital stay.
Keywords: Epidural analgesia; Fast track; Liver surgery; Major hepatectomy; Postoperative recovery protocol.
Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
Source: PubMed