title: Epidural anesthesia and analgesia in liver resection: Safety and effectiveness.
abstract: OBJECTIVE
  Perioperative epidural analgesia in liver resection provides optimal dynamic pain relief. Coagulation disorders occurring in the postoperative period can lead to greater risk of complications during epidural catheter removal. The aim of this study is to evaluate the effectiveness and complications of epidural analgesia and delayed epidural catheter removal due to postoperative coagulopathy.
  
  
  METHODS
  A retrospective study of 114 patients undergoing open liver resection and epidural analgesia, from March 2012 to February 2015. Postoperative course of pain intensity, coagulation parameters and delayed catheter removal was analyzed RESULTS: Of the 114 operated patients, 73 met the inclusion criteria. 59% of patients received major hepatectomy (resection ≥ 3 segments) and 15% had Child's Class A cirrhosis (11/73). 96% of catheters functioned properly. 89% of patients had controlled pain (numerical rate scale <3) at rest and 8.2% (6 patients) had severe pain (numerical rate scale > 6) with movement. The INR peaked on postoperative day 2, 1.41 [0.99-2.30], and gradually returned to normal values in most patients by postoperative day 4, 1.26 [0.90 - 2.20]. The catheters were left in place 3.6 (± 1.1) days. In 6 patients (8%), catheter removal was postponed due to coagulation disorders.
  
  
  CONCLUSIONS
  Epidural analgesia for liver resection was a safe practice, which produced optimal control of postoperative pain. The percentage of delayed catheter removal due to postoperative coagulopathy was low, not requiring transfusion of blood products.
authors.affiliation: Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Universitario Son Espases, Palma de Mallorca, España. Electronic address: neus.esteve@ssib.es.
authors.forename: N
authors.initials: N
authors.lastname: Esteve
authors.affiliation: Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Universitario Son Espases, Palma de Mallorca, España.
authors.forename: A
authors.initials: A
authors.lastname: Ferrer
authors.affiliation: Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Universitario Son Espases, Palma de Mallorca, España.
authors.forename: C
authors.initials: C
authors.lastname: Sansaloni
authors.affiliation: Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Universitario Son Espases, Palma de Mallorca, España.
authors.forename: M
authors.initials: M
authors.lastname: Mariscal
authors.affiliation: Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Universitario Son Espases, Palma de Mallorca, España.
authors.forename: M
authors.initials: M
authors.lastname: Torres
authors.affiliation: Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Universitario Son Espases, Palma de Mallorca, España.
authors.forename: C
authors.initials: C
authors.lastname: Mora
mesh_terms: D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000295:instrumentation; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000295:instrumentation; D001778:Blood Coagulation Disorders / Q000209:etiology; D001803:Blood Transfusion; D057785:Catheters; D020878:Device Removal; D005260:Female; D006498:Hepatectomy; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000009:adverse effects / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies
keywords: Analgesia epidural; Enhanced-recovery after surgery hepatectomy; Enhanced-recovery after surgery hepatectomía; Epidural analgesia; Epidural haematoma; Hematoma epidural; Hepatectomy; Hepatectomy postoperative analgesia; Hepatectomía; Hepatectomía analgesia postoperatoria