title: Effect of epidural compared to patient-controlled intravenous analgesia on outcomes for patients undergoing liver resection for neoplastic disease.
abstract: BACKGROUND
  Epidural analgesia is routinely used for postoperative pain control following abdominal surgeries, yet data regarding the safety and efficacy of epidural analgesia is controversial.
  
  
  METHODS
  Pain-related and clinical perioperative data were extracted and correlated with baseline clinicopathologic data and method of analgesia (epidural vs. intravenous patient-controlled analgesia) in patients who underwent hepatectomy from 2012 to 2014. Chronic pain was defined by specific narcotic requirements preoperatively.
  
  
  RESULTS
  Eighty-seven patients underwent hepatectomy with 60% having epidurals placed for postoperative pain control. Epidural patients underwent more major hepatectomies and open resections. Comparison of pain scores between both groups demonstrated no significant difference (all P > .05). A significantly lower proportion of TEA patients required additional IV pain medications than those with IVPCA (P < 0.001). There was no major effect of epidural analgesia on time to ambulation or complications (all P > 0.05). After adjusting for perioperative factors, and surgical extent and approach, no significant differences in fluids administered or length of stay were detected.
  
  
  CONCLUSIONS
  Overall postoperative outcomes were not significantly different based on method of analgesia after adjusting for type and extent of hepatic resection. Though patients with epidurals underwent more extensive operations they required less additional IV pain medications than IVPCA patients.
authors.affiliation: Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Shelby
authors.initials: S
authors.lastname: Allen
authors.affiliation: Department of Anesthesiology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
authors.forename: Amy
authors.initials: A
authors.lastname: DeRoche
authors.affiliation: Department of Anesthesiology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
authors.forename: Lu
authors.initials: L
authors.lastname: Adams
authors.affiliation: Department of Anesthesiology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
authors.forename: Karen Valerie
authors.initials: KV
authors.lastname: Slocum
authors.affiliation: Section of Surgical Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
authors.forename: Clancy J
authors.initials: CJ
authors.lastname: Clark
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Nora F
authors.initials: NF
authors.lastname: Fino
authors.affiliation: Section of Surgical Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
authors.forename: Perry
authors.initials: P
authors.lastname: Shen
mesh_terms: D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data; D006498:Hepatectomy; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D012189:Retrospective Studies; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents
keywords: analgesia; epidural; hepatectomy