title: Effect of analgesic modality on outcome following open liver surgery: a systematic review of postoperative analgesia.
abstract: Postoperative analgesia following liver resection remains controversial. The traditional standard of care of thoracic epidural is increasingly questioned due to perceived associated complications and delays to recovery. Evidence supporting alternative analgesic techniques is emerging however best practice is not yet established. This review aimed to evaluate the literature to assess the optimum analgesic technique following liver resection. A systematic review was conducted of trials evaluating analgesic methods in open liver surgery. Primary outcome was the postoperative complication rate. Secondary outcomes were length of stay and pain scores. Fourteen trials matching the inclusion criteria were analysed. No difference was observed in systemic complication rates between analgesic modalities. Epidural was associated with prolonged length of stay when compared with continuous wound infiltration and intrathecal morphine. Epidural offered equivalent or superior pain scores when compared to alternative techniques. In summary current evidence suggests alternative analgesic modalities may provide favorable recovery outcomes following liver surgery but consistent evidence is limited. Epidurals provide superior pain relief to alternatives but this does not translate into reduced length of stay or complication rate following liver surgery.
authors.affiliation: Department of Clinical Surgery, Royal Infirmary, Edinburgh, UK - michaelh@doctors.net.uk.
authors.forename: M
authors.initials: M
authors.lastname: Hughes
authors.forename: S
authors.initials: S
authors.lastname: McNally
authors.forename: D W
authors.initials: DW
authors.lastname: McKeown
authors.forename: S
authors.initials: S
authors.lastname: Wigmore
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006760:Hospitalization; D006801:Humans; D008099:Liver / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010149:Postoperative Pain / Q000188:drug therapy*; D016896:Treatment Outcome