title: Epidural analgesia in hepatic resection.
abstract: BACKGROUND
  Randomized trials show equivocal benefit of epidural analgesia (EA) for patients undergoing abdominal operations. Partial hepatectomy is often performed using low central venous pressure anesthesia to reduce intraoperative blood loss. We examined effects of pain management strategy on blood pressure, transfusion, and complications in patients undergoing hepatic resection with either EA or IV analgesia (IVA).
  
  
  METHODS
  Data on patients undergoing hepatectomy from 2001 to 2004 at Emory University Hospital were analyzed according to route of perioperative pain management. Patient and treatment factors were analyzed for associations with transfusion and morbidity.
  
  
  RESULTS
  From 2001 through 2004, 367 patients underwent elective partial hepatectomy at Emory University Hospital. EA patients were more likely to be older, men, and with malignancy. There were no differences between the groups in extent of resection, operative time, blood loss, or starting hematocrit level. The EA group had lower mean arterial pressure in recovery (86.6+/-14.0 mmHg versus 94.5+/-13.2 mmHg, p < 0.001) and were more likely to be transfused with packed red cells during the hospital course (44.5% versus 27.9%, p < 0.001). On multivariate analysis, age greater than 65 years, American Society of Anesthesiologists grade>2, starting hematocrit<38%, operative time>300 minutes, blood loss>1 L, and use of EA were associated with increased numbers of patients receiving packed red blood cells. Complications and length of stay were similar for both groups.
  
  
  CONCLUSIONS
  Epidural analgesia was independently associated with increased risk of packed red blood cell transfusion after hepatectomy. EA did not appear to minimize complications or shorten hospital stay. Caution should be exercised when considering EA use in hepatic resection.
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Page
authors.forename: Bradley
authors.initials: B
authors.lastname: Rostad
authors.forename: Charles A
authors.initials: CA
authors.lastname: Staley
authors.forename: Jerold H
authors.initials: JH
authors.lastname: Levy
authors.forename: Jaemin
authors.initials: J
authors.lastname: Park
authors.forename: Michael
authors.initials: M
authors.lastname: Goodman
authors.forename: Juan M
authors.initials: JM
authors.lastname: Sarmiento
authors.forename: John
authors.initials: J
authors.lastname: Galloway
authors.forename: Keith A
authors.initials: KA
authors.lastname: Delman
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
mesh_terms: D015360:Analgesia, Epidural; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008107:Liver Diseases / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome