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.
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.


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.
Center for Hepato-Pancreato-Biliary Surgery, "Euromedica Geniki Kliniki" General Hospital, 2, Gravias Street, 54645 Thessaloniki, Greece. Electronic address: achippo@hotmail.com.
A
A
Ntinas
D
D
Kardassis
I
I
Konstantinopoulos
P
P
Kottos
A
A
Manias
M
M
Kyritsi
D
D
Zilianiaki
D
D
Vrochides
D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016022:Case-Control Studies; D002404:Catheterization; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications
Epidural analgesia; Fast track; Liver surgery; Major hepatectomy; Postoperative recovery protocol