Epidural anesthesia and analgesia in liver resection: Safety and effectiveness
详细信息 查看全文
- 作者：N. Esteve ; neus.esteve@ssib.es ; A. Ferrer ; C. Sansaloni ; M. Mariscal ; M. Torres ; C. Mora
- 关键词：Epidural analgesia ; Hepatectomy ; Hepatectomy postoperative analgesia ; Epidural haematoma ; Enhanced-recovery after surgery hepatectomy
- 刊名：Revista Española de Anestesiología y Reanimación (English Edition)
- 出版年：2017
- 出版时间：February 2017
- 年：2017
- 卷：64
- 期：2
- 页码：86-94
- 全文大小：810 K
- 卷排序：64
文摘
Perioperative epidural analgesia in liver resection provides optimal dynamic pain relief. Coagulation disorders occurring in the postoperative period can lead to greater risk of complications during epidural catheter removal.The aim of this study is to evaluate the effectiveness and complications of epidural analgesia and delayed epidural catheter removal due to postoperative coagulopathy.MethodsA retrospective study of 114 patients undergoing open liver resection and epidural analgesia, from March 2012 to February 2015. Postoperative course of pain intensity, coagulation parameters and delayed catheter removal was analysed.ResultsOf the 114 operated patients, 73 met the inclusion criteria. 59% of patients received major hepatectomy (resection ≥3 segments) and 15% had Child's Class A cirrhosis (11/73). 96% of catheters functioned properly. 89% of patients had controlled pain (numerical rate scale <3) at rest and 8.2% (6 patients) had severe pain (numerical rate scale >6) with movement.The INR peaked on postoperative day 2, 1.41 [0.99–2.30], and gradually returned to normal values in most patients by postoperative day 4, 1.26 [0.90–2.20]. The catheters were left in place 3.6 (±1.1) days. In 6 patients (8%), catheter removal was postponed due to coagulation disorders.ConclusionsEpidural analgesia for liver resection was a safe practice, which produced optimal control of postoperative pain. The percentage of delayed catheter removal due to postoperative coagulopathy was low, not requiring transfusion of blood products.