title: Epidural analgesia provides effective pain relief in patients undergoing open liver surgery.
abstract: BACKGROUND
  Epidural analgesia has been the reference standard for the provision of post-operative pain relief in patients recovering from major upper abdominal operations, including liver resections. However, a failure rate of 20-32% has been reported.
  
  
  OBJECTIVE
  The aim of the study was to analyse the success rates of epidural analgesia and the outcome in patients who underwent liver surgery.
  
  
  METHODS
  We collected data from a prospectively maintained database of 70 patients who underwent open liver surgery by a bilateral subcostal incision during a period of 20 months (February 2009 to September 2010). Anaesthetic consultants with expertise in anaesthesia for liver surgery performed the epidural catheter placement. A dedicated pain team assessed the post-operative pain scores on moving or coughing using the Verbal Descriptor Scale. The outcome was measured in terms of epidural success rates, pain scores, post-operative chest infection and length of hospital stay.
  
  
  RESULTS
  The study group included 43 males and 27 females. The indication for resection was liver secondaries (70%), primary tumours (19%) and benign disease (11%). While major (≥3 segments) and minor resections (≤ 2 segments) were performed in 44% and 47% respectively, 9% of patients were inoperable. Epidural analgesia was successful in 64 patients (91%). Bacterial colonisation of epidural tip was noticed in two patients. However, no neurological complications were encountered. Five patients (7%) had radiologically confirmed chest infection. Four patients (6%) developed wound infection. One patient died due to liver failure following extended right hepatectomy and cholecystectomy for gall bladder cancer. The median length of stay was 6 days (3-27 days). The extent of liver resection (p = 0.026) and post-operative chest infection (p = 0.012) had a significant influence on the length of stay.
  
  
  CONCLUSIONS
  Our experience shows that epidural analgesia is safe and effective in providing adequate pain relief following open liver surgery.
authors.affiliation: Cardiff Liver Unit, University Hospital of Wales, Cardiff, UK.
authors.forename: Senthil
authors.initials: S
authors.lastname: Ganapathi
authors.affiliation: Acute Pain Service, University Hospital of Wales, Cardiff, UK.
authors.forename: Gemma
authors.initials: G
authors.lastname: Roberts
authors.affiliation: Acute Pain Service, University Hospital of Wales, Cardiff, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Mogford
authors.affiliation: Department of Anaesthesia, University Hospital of Wales, Cardiff, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bahlmann
authors.affiliation: Department of Anaesthesia, University Hospital of Wales, Cardiff, UK.
authors.forename: Bazil
authors.initials: B
authors.lastname: Ateleanu
authors.affiliation: Cardiff Liver Unit, University Hospital of Wales, Cardiff, UK.
authors.forename: Nagappan
authors.initials: N
authors.lastname: Kumar
keywords: Epidural analgesia; acute pain; drug therapy; liver surgery; prevention and control