title: Epidural analgesia and liver resection: postoperative coagulation disorders and epidural catheter removal.
abstract: BACKGROUND
  The aim of this study was to quantify the duration and severity of postoperative coagulopathy in order to establish the optimal time for epidural catheter removal.
  
  
  METHODS
  In a 2-year retrospective study, 140 consecutive patients underwent major liver resection.
  
  
  RESULTS
  Epidural catheters were present in 123 patients (87.9%). Resections were: 33 (26.8%) right hepatectomy (with or without left metastasectomy), 9 (7.3%) left hemihepatectomy (with or without right metastasectomy), 37 (30.1%) trisectionectomy (extended hemihepatectomy) and 44 (35.8%) non-anatomical metastasectomy. Surgery was quantified by segments resected (4 [range: 1-7]). Vascular inflow occlusion was used in 65.6%. Ischaemic time was 26.5 min (range: 0-104 min). Platelet count fell postoperatively and was lowest on day 2 (205±72 10(9) L(-1)). There was a significant increase in prothrombin time, activated partial thromboplastin time and International Normalised Ratio (INR) postoperatively, peaking on day 2 (21.5±5.6 s, 37.9±5.8 s and 1.9±0.5, respectively). Changes persisted beyond day 6. Epidural catheters were removed on day 5 (1-11), with a protocol criterion of INR <1.2. Actual INR on day 5 was 1.49±0.36.
  
  
  CONCLUSIONS
  Despite this, no epidural or spinal haematoma was recorded.
authors.affiliation: Department of Anaesthesia, St James's University Hospital, Leeds, UK.
authors.forename: D M
authors.initials: DM
authors.lastname: Stamenkovic
authors.forename: Z B
authors.initials: ZB
authors.lastname: Jankovic
authors.forename: G J
authors.initials: GJ
authors.lastname: Toogood
authors.forename: J P A
authors.initials: JP
authors.lastname: Lodge
authors.forename: M C
authors.initials: MC
authors.lastname: Bellamy
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000628:therapy*; D001803:Blood Transfusion; D002404:Catheterization; D015179:Colorectal Neoplasms / Q000473:pathology; D017984:Enoxaparin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D019934:International Normalized Ratio; D008099:Liver / Q000601:surgery*; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D011183:Postoperative Complications / Q000628:therapy*; D011517:Prothrombin Time; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin