title: Role of epidural anesthesia in a fast track liver resection protocol for cirrhotic patients - results after three years of practice.
abstract: OBJECTIVE
  To evaluate the potential benefits and risks of the use of epidural anaesthesia within an enhanced recovery protocol in this specific subpopulation.
  
  
  METHODS
  A retrospective review was conducted, including all cirrhotic patients who underwent open liver resection between January 2013 and December 2015 at Bologna University Hospital. Patients with an abnormal coagulation profile contraindicating the placement of an epidural catheter were excluded from the analysis. The control group was composed by patients refusing epidural anaesthesia.
  
  
  RESULTS
  Of the 183 cirrhotic patients undergoing open liver resections, 57 had contraindications to the placement of an epidural catheter; of the remaining 126, 86 patients received general anaesthesia and 40 combined anaesthesia. The two groups presented homogeneous characteristics. Intraoperatively the metabolic data did not differ between the two groups, whilst the epidural group had a lower mean arterial pressure (P = 0.041) and received more colloid infusions (P = 0.007). Postoperative liver and kidney function did not differ significantly. Length of mechanical ventilation (P = 0.003) and hospital stay (P = 0.032) were significantly lower in the epidural group. No complications related to the epidural catheter placement or removal was recorded.
  
  
  CONCLUSIONS
  The use of Epidural Anaesthesia within a fast track protocol for cirrhotic patients undergoing liver resections had a positive impact on the patient's outcomes and comfort as demonstrated by a significantly lower length of mechanical ventilation and hospital stay in the epidural group. The technique appears to be safely manageable in this fragile population even though these results need confirmation in larger studies.
authors.affiliation: Antonio Siniscalchi, Lorenzo Gamberini, Tommaso Bardi, Cristiana Laici, Elisa Gamberini, Letizia Francorsi, Stefano Faenza, Division of Anesthesiology, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Siniscalchi
authors.affiliation: Antonio Siniscalchi, Lorenzo Gamberini, Tommaso Bardi, Cristiana Laici, Elisa Gamberini, Letizia Francorsi, Stefano Faenza, Division of Anesthesiology, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Gamberini
authors.affiliation: Antonio Siniscalchi, Lorenzo Gamberini, Tommaso Bardi, Cristiana Laici, Elisa Gamberini, Letizia Francorsi, Stefano Faenza, Division of Anesthesiology, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Bardi
authors.affiliation: Antonio Siniscalchi, Lorenzo Gamberini, Tommaso Bardi, Cristiana Laici, Elisa Gamberini, Letizia Francorsi, Stefano Faenza, Division of Anesthesiology, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Laici
authors.affiliation: Antonio Siniscalchi, Lorenzo Gamberini, Tommaso Bardi, Cristiana Laici, Elisa Gamberini, Letizia Francorsi, Stefano Faenza, Division of Anesthesiology, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Gamberini
authors.affiliation: Antonio Siniscalchi, Lorenzo Gamberini, Tommaso Bardi, Cristiana Laici, Elisa Gamberini, Letizia Francorsi, Stefano Faenza, Division of Anesthesiology, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy.
authors.forename: Letizia
authors.initials: L
authors.lastname: Francorsi
authors.affiliation: Antonio Siniscalchi, Lorenzo Gamberini, Tommaso Bardi, Cristiana Laici, Elisa Gamberini, Letizia Francorsi, Stefano Faenza, Division of Anesthesiology, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Faenza
keywords: Analgesia; Anesthesia; Complication; Epidural; Liver cirrhosis; Liver function tests; Postoperative; Postoperative care