title: Randomized clinical trial of perioperative nerve block and continuous local anaesthetic infiltration via wound catheter versus epidural analgesia in open liver resection (LIVER 2 trial).
abstract: BACKGROUND
  Analgesia after liver surgery remains controversial. A previous randomized trial of continuous wound infiltration (CWI) versus thoracic epidural analgesia (TEA) after liver surgery (LIVER trial) showed a faster recovery time in the wound infiltration group but better early postoperative pain scores in the TEA group. High-level evidence is, however, limited and opinion remains divided. The aim was to determine whether there is a difference in functional recovery time between patients having CWI plus abdominal nerve blocks versus TEA after liver resection.
  
  
  METHODS
  A randomized unblinded clinical trial of patients undergoing open liver resection was commenced in December 2012, with follow-up to August 2014. Patients were randomized to receive either wound catheter and nerve block (CWI group) or TEA for 48 h after surgery. The primary outcome measure was functional recovery time. Secondary outcomes were pain scores, complication rates, inflammatory response and central venous pressure (CVP) during transection.
  
  
  RESULTS
  Of 50 patients randomized initially to each group, 44 received TEA and 49 CWI. Median (i.q.r.) recovery time was 6·5 (5-9·75) and 5·75 (4-7) days in the TEA and CWI groups respectively (P = 0·036). Pain scores were not significantly different between the two groups, and there were no differences in morbidity, inflammatory response or CVP during transection.
  
  
  CONCLUSIONS
  Wound infiltration is associated with a reduced time to recovery after open liver resection compared with epidural analgesia. TEA does not offer an advantage over CWI in terms of attenuation of the inflammatory response or pain scores.
  
  
  BACKGROUND
  NCT01747122 ( http://www.clinicaltrials.gov).
authors.affiliation: Departments of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Hughes
authors.affiliation: Departments of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: E M
authors.initials: EM
authors.lastname: Harrison
authors.affiliation: Departments of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Peel
authors.affiliation: Departments of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: B
authors.initials: B
authors.lastname: Stutchfield
authors.affiliation: Departments of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: S
authors.initials: S
authors.lastname: McNally
authors.affiliation: Departments of Anaesthesia, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: C
authors.initials: C
authors.lastname: Beattie
authors.affiliation: Departments of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Wigmore
mesh_terms: D015360:Analgesia, Epidural / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D057785:Catheters; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D019990:Perioperative Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome