Coagulation profile changes and safety of epidural analgesia after hepatectomy: a retrospective study

Elterman, Kelly; Xiong, Zhiling

doi:10.1007/s00540-014-1933-4

Cited by 24 publications

(28 citation statements)

References 21 publications

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“…None of the patients in our study developed TEA hematomas or abscesses, although 7.5% had delayed catheter removal due to changes in coagulation profiles. These results are in agreement from a study by Elterman and Xiong, indicating that epidural analgesia can be safe in patients undergoing liver resection.…”

Section: Discussionsupporting

confidence: 92%

“…Although epidural analgesia has been shown to be beneficial in many types of abdominal surgeries, there is special concern for its use in hepatectomy patients due to complications related to coagulopathy and increased transfusion requirements. Multiple studies have indicated that changes in coagulation profiles occur in patients undergoing liver resections, leading to a theoretical increased risk for epidural hematoma formation following epidural catheter removal. However, Elterman and Xiong reported that in spite of increased PT and INR and decreased platelet counts, none of the hepatectomy patients in their study who received epidurals developed epidural hematomas .…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have indicated that changes in coagulation profiles occur in patients undergoing liver resections, leading to a theoretical increased risk for epidural hematoma formation following epidural catheter removal. However, Elterman and Xiong reported that in spite of increased PT and INR and decreased platelet counts, none of the hepatectomy patients in their study who received epidurals developed epidural hematomas . Another study reported an increased risk of packed red blood cell transfusion associated with epidurals in hepatectomy patients, as compared to patients receiving intravenous analgesia …”

Section: Discussionmentioning

confidence: 99%

“…However, Elterman and Xiong reported that in spite of increased PT and INR and decreased platelet counts, none of the hepatectomy patients in their study who received epidurals developed epidural hematomas. 8 Another study reported an increased risk of packed red blood cell transfusion associated with epidurals in hepatectomy patients, as compared to patients receiving intravenous analgesia. 11 However, regional anesthesia may also have benefits in abdominal surgery.…”

Section: Discussionmentioning

confidence: 99%

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Effect of epidural compared to patient‐controlled intravenous analgesia on outcomes for patients undergoing liver resection for neoplastic disease

Allen

DeRoche

Adams

et al. 2017

Journal of Surgical Oncology

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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 versus 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.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of epidural compared to patient‐controlled intravenous analgesia on outcomes for patients undergoing liver resection for neoplastic disease

Allen

DeRoche

Adams

et al. 2017

Journal of Surgical Oncology

View full text Add to dashboard Cite

show abstract

“…The degree of post-operative coagulopathy can be related to preoperative liver synthetic function. Thus, this transient post-operative coagulopathy is typically maximally deranged on postoperative days one and two and typically resolves on its own within ive to seven days [3,4]. Therefore, there may be some hesitation by anesthesia providers to use epidural analgesia perioperatively for this procedure.…”

Section: Introductionmentioning

confidence: 99%

Effects of intraoperative epidural anesthesia during hepatectomy on intraoperative and post-operative patient outcomes

Mallard¹,

Withers²,

Bauer³

et al. 2018

Int J Clin Anesth Res

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Objective: The objective of this study was to evaluate the effects of intraoperative epidural anesthesia combined with balanced general anesthesia on intraoperative hemodynamics and fl uid requirement, and on postoperative patient outcome. Design: The study design was a retrospective data analysis of patients undergoing open hepatectomy at a single tertiary care center from May, 2013 to June, 2016. Patients undergoing hepatectomies were separated into two groups: patients not receiving epidural local anesthetic intraoperatively (either no epidural or epidural catheter not used intraoperatively) were designated the control group and patients receiving epidural local anesthetic intraoperatively (bolus and/or continuously). Patients were excluded if they underwent laparoscopic or non-elective procedures. Results: 103 patients were included in the data analysis: Control n=14, Epidural = 89 patients. There were no major differences in demographics between groups. Epidural patients did not have higher requirements in intraoperative intravenous fl uid administration, blood loss, or vasopressor use compared to control patients. Patients who received epidurals required less intravenous opioids with better postoperative pain scores initially and also on post-operative day 2. There were no differences in length of time to ambulation, or post-operative acute kidney injury amongst groups. Conclusions: This study shows that patients undergoing hepatectomies using combined epidural and general anesthesia: 1) have no increased requirement for intraoperative crystalloid, colloid, or blood component therapy, 2) require lower total intravenous opioid dose, and 3) subjectively report better pain control. Therefore, intraoperative epidural anesthesia combined with general anesthesia may be advantageous for ERAS protocol based oncological procedures.

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Thoracic epidural analgesia in donor hepatectomy: An analysis

et al. 2018

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The purpose of this study is to analyze whether supplementation of general anesthesia (GA) with thoracic epidural analgesia (TEA) for right lobe donor hepatectomy is a safe modality of pain relief in terms of changes in postoperative coagulation profile, incidence of epidural catheter-related complications, and timing of removal of epidural catheter. Retrospective analysis of the record of 104 patients who received TEA for right lobe donor hepatectomy was done. Platelet count, international normalized ratio, alanine aminotransferase, and aspartate aminotransferase were recorded postoperatively until the removal of the epidural catheter. The day of removal of the epidural catheter and visual analogue scale (VAS) scores were also recorded. Any complication encountered was documented. Intraoperatively, central venous pressure (CVP), hemodynamic variables, and volume of intravenous fluids infused were also noted. Statistical analysis was performed by using SPSS statistical package, version 17.0 (SPSS Inc. Chicago, IL). Continuous variables were presented as mean ± standard deviation. A total of 90% of patients had mean VAS scores between 1 and 4 in the postoperative period between days 1 and 5. None of the patients had a VAS score above 5. Although changes in coagulation status were encountered in all patients in the postoperative period, these changes were transient and did not persist beyond postoperative day (POD) 5. There was no delay in removal of the epidural catheter, and the majority of patients had the catheter removed by POD 4. There was no incidence of epidural hematoma. Aside from good intraoperative and postoperative analgesia, TEA in combination with balanced GA and fluid restriction enabled maintenance of low CVP and prevention of hepatic congestion. In conclusion, vigilant use of TEA appears to be safe during donor hepatectomy. Living liver donors should not be denied efficient analgesia for the fear of complications. Liver Transplantation 24 214-221 2018 AASLD.

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Coagulation profile changes and safety of epidural analgesia after hepatectomy: a retrospective study

Abstract: Epidural analgesia may be safely used in patients undergoing major hepatic resection, providing that they have normal pre-operative coagulation and catheters are removed only when resection-induced perioperative coagulopathy has resolved or has been corrected.

Cited by 24 publications

References 21 publications

Effect of epidural compared to patient‐controlled intravenous analgesia on outcomes for patients undergoing liver resection for neoplastic disease

Effect of epidural compared to patient‐controlled intravenous analgesia on outcomes for patients undergoing liver resection for neoplastic disease

Effects of intraoperative epidural anesthesia during hepatectomy on intraoperative and post-operative patient outcomes

Thoracic epidural analgesia in donor hepatectomy: An analysis

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