A prospective cohort study of intrathecal versus epidural analgesia for patients undergoing hepatic resection.
BACKGROUND
The aim of this prospective observational study was to compare peri/post-operative outcomes of thoracic epidural analgesia (TEA) versus intrathecal morphine and fentanyl patient-controlled analgesia (ITM+fPCA) for patients undergoing a hepatic resection (HR).


METHODS
Patients undergoing elective, one-stage, open HR for benign and malignant liver lesions, receiving central neuraxial block as part of the anaesthetic, in a high-volume hepato-pancreato-biliary unit, were included in the study. The primary outcome measure was post-operative length of stay (LoS).


RESULTS
A total of 73 patients (36 TEA and 37 ITM+fPCA) were included in the study. The median (IQR) post-operative LoS was 13 (11-15) and 11 (9-13) days in the TEA and ITM+fPCA groups, respectively (P = 0.011). There was significantly lower median intra-operative central venous pressure (P < 0.001) and blood loss (P = 0.017) in the TEA group, and a significant reduction in the time until mobilization (P < 0.001), post-operative intra-venous fluid/vasopressor requirement (P < 0.001/P = 0.004) in the ITM+fPCA group. Pain scores were lower at a clinically significant level 12 h post-operatively in the TEA group (P < 0.001); otherwise there were no differences out to day five. There were no differences in quality of recovery or postoperative morbidity/mortality between the two groups.


CONCLUSIONS
ITM+fPCA provides acceptable post-operative outcomes for HR, but may also increase the incidence of intra-operative blood loss in comparison to TEA.
Department of Anaesthesia, Royal Free London NHS Foundation Trust, London, UK.
Ramanathan
R
Kasivisvanathan
Nima
N
Abbassi-Ghadi
Jeremy
J
Prout
Ben
B
Clevenger
Giuseppe K
GK
Fusai
Susan V
SV
Mallett
D015360:Analgesia, Epidural / Q000009:adverse effects; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D016063:Blood Loss, Surgical; D005283:Fentanyl / Q000008:administration & dosage; D006498:Hepatectomy / Q000009:adverse effects*; D061847:Hospitals, High-Volume; D006801:Humans; D007902:Length of Stay; D008131:London; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D009020:Morphine; D005283:Fentanyl