Epidural Analgesia in Hepatic Resection

For Patients Undergoing Pancreatoduodenectomy, Epidural Anesthesia and Analgesia Improves Pain But Increases Rates of Intensive Care Unit Admissions and Alterations in Analgesics

“…Other studies have demonstrated this apparent dichotomy. 17 Although this may provide an interesting material for further study, it was beyond the capacities of the present work. Second, because of self-selection, it was not unexpected that compared with the non-EAA group, patients in the EAA group were more likely to require changes to their analgesic regimens.…”

“…Indeed, other studies have demonstrated that EAA was associated with highly complex and relatively unpredictable fluid shifts and increased rates of packed red blood cell count transfusions. 8,13,17,19,20 With EAA, pharmacologically induced smooth muscle dilation allowed for increased vascular capacitance, relative hypotension, intravenous fluidYmediated hemodilution, and red blood cell count transfusions. However, this would not explain a near doubling of intraoperative blood loss for patients with EAA compared with patients without EAA.…”

“…13,21 The limitations of this study were many: it was retrospective with the inherent and numerous drawbacks thereof (for example, as it was impossible to recreate the circumstances surrounding operating room delays, epidural catheterization may not have been the only reason that a patient arrived late to the operating room. Therefore, although data were available, their validity and implications were difficult to determine; its study population was small and was therefore unable to achieve statistical significance or adequate power for most variables; the study groups did not include similar ratios of men and women 17 ; the 2 study groups were managed by 2 different services (one staffed by anesthesiologists and another by surgeons); because there was no standard protocol for either group, pharmacologic regimens varied from patient to patient; the results were largely underpowered. Moreover, given its small number of patients, this study was unable to demonstrate statistical equivalences; it was only able to achieve statistical differences for few factors with modest power values.…”

A Randomized Controlled Trial of Postoperative Thoracic Epidural Analgesia Versus Intravenous Patient-controlled Analgesia After Major Hepatopancreatobiliary Surgery

“…Multiple non-randomized comparisons have been reported, however, relatively few level 1 data from randomized trials are available. [22–28] Currently, the advantages and disadvantages between these two strategies continue to be debated, and the most effective strategy has not been determined. The objective of this randomized control trial (RCT) was to compare the efficacy of pain control and safety between TEA and IV-PCA.…”

The analgesic efficacy of continuous wound instillation with ropivacaine after open hepatic surgery

“…Although epidural analgesia has been shown to be effective after hepatic resection without complication [22], the debate on epidural analgesia continues [23][24][25]. Coagulopathy, thrombocytopenia and other haematological abnormalities may impose additional risks of epidural haematoma formation following removal of the epidural catheter postoperatively.…”