Evaluation of Epidural Analgesia for Open Major Liver Resection Surgery from a us Inpatient Sample

Rosero, Eric B.; Cheng, Gloria; Khatri, Kinnari P.; Joshi, Girish P.

doi:10.1080/08998280.2014.11929141

Cited by 17 publications

(17 citation statements)

References 34 publications

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“…Clarke et al (18) in a retrospective study suggested analgesic superiority when using epidurals for analgesia during LDLT surgery. However, there are inherent risks of neuraxial hematoma -despite the fact that liver donors have normal preoperative liver function (19) -due to unanticipated coagulation derangements from such surgery that could result in a catastrophic neuraxial hematoma making regional techniques controversial for these patients (20). In addition, certain non-narcotic analgesics (NSAIDs) used alone or in combination with neuraxial techniques can be impact modifiers of the coagulation system, and these carry risks that might result in adverse influences on coagulation and platelet-inhibition (increasing the risk of surgical bleeding) and should receive risk-to-benefit consideration in LDLT patients (21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

Donor Hepatectomy Surgery using Ketamine to Compliment Analgesia and Reduce Morbidity - a Retrospective Chart Review Investigation

Halaszynski

Dai

Huang

2018

Turk J Anaesth Reanim

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Objective: Inferior and limited analgesic options/techniques during living donor hepatectomy surgery can result in pain and risks of morbidity, opioid-related adverse events (AEs), predisposition to the development of chronic pain and concerns of potential narcotic abuse. Traditional analgesia uses unimodal intravenous opioids that can cause significant side effects. Ketamine provides analgesia and may be opioid sparing, but use in living-donor hepatectomy has not been studied. Methods: Following human investigation committee approval and informed written consent, 47 liver donor patients over a 5-year period scheduled for surgery were categorized into one of three groups: 24 patients received no ketamine (Group 1), 9 received only intraoperative ketamine (Group 2) and 14 patients received intraoperative plus postoperative ketamine (Group 3). Subjects had access to opioid patient-controlled analgesia (PCA). Chart reviews (including operating room and intensive care unit) were collected and analysed for morphine consumption, pain-intensity scores, opioid-sparing effects, AEs of analgesics and for evidence of ketamine side effects on donor hepatectomy patients. Results: There were no differences in patient demographics. Living donor hepatectomy patients receiving intraoperative ketamine that was continued postoperatively consumed fewer morphine-equivalents and had lower median pain scores than subjects from the other two groups. Ileus occurred in those not receiving ketamine, pruritus was lowest in Group 3, and there was no evidence or reports of ketamine-associated AEs. Conclusion: Perioperative ketamine for donor hepatectomy patients could safely provide improved analgesia and be opioid sparing when compared to PCA opioids alone, and there is no evidence of ketamine-related AEs at the dose and delivery methods described here during partial liver donation surgery. Keywords: Living-donor liver transplantation, ketamine, perioperative analgesia Amaç: Canlı donörlü hepatektomi ameliyatı sırasında uygulanan inferior ve sınırlı analjezi seçenekleri/teknikleri ağrıya ve morbidite riskine, opioide bağlı yan etkilere, kronik ağrı gelişimi eğilimine ve potansiyel narkotik bağımlılığına neden olabilirler. Geleneksel analjezi uygulamasında, önemli yan etkilere neden olabilen unimodal intravenöz opioidler kullanılmaktadır. Ketamin analjezi sağlar ve opioid tüketimini azaltabilir. Ancak canlı donörlü hepatektomide kullanımı hakkında henüz çalışma yapılmamıştır. Yöntemler: İnsan araştırmaları etik kurulu onayı ve yazılı bilgilendirilmiş hasta onam formu alındıktan sonra, 5 yıllık bir süreçte ameliyat olması planlanan 47 canlı donör hastası 3 gruba ayrıldı. 24 hastaya hiç ketamin verilmedi (Grup 1); 9 hastaya sadece intraoperatif ketamin verildi (Grup 2); ve 14 hastaya intraoperatif ve postoperatif ketamine uygulandı (Grup 3). Denekler hasta kontrollü opioid analjezisi kullandılar. Hastaların tıbbi kayıtları toplandı (ameliyathane ve yoğun bakım ünitesinden) ve morfin kullanımı, ağrı-yoğunluk skorları, opioid tüketiminin azaltıc...

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Section: Discussionmentioning

confidence: 99%

Donor Hepatectomy Surgery using Ketamine to Compliment Analgesia and Reduce Morbidity - a Retrospective Chart Review Investigation

Halaszynski

Dai

Huang

2018

Turk J Anaesth Reanim

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“…Postoperative variables included NRS scores, cumulative sufentanil consumption, the incidence of PONV. Ramsay Sedation Scale scores [ 11 ] collected 5 min after extubation, and 2 h, 4 h, 12 h and 24 h after the operation was evaluated as: [ 1 ] the patient is anxious and agitated or restless, or both; [ 2 ] the patient is co-operative, oriented and tranquil; [ 3 ] the patient responds to commands only; [ 4 ] the patient exhibits brisk response to light glabellar tap or loud auditory stimulus; [ 5 ] the patient exhibits a sluggish response to light glabellar tap or loud auditory stimulus; and [ 6 ] the patient exhibits no response.…”

Section: Methodsmentioning

confidence: 99%

“…Epidural analgesia, another routinely used analgesic technique, offers equivalent or superior pain scores when compared toconventional systemic opioids. However, its utilizationis limited by perioperative coagulation dysfunction, which is typical in the patients for liver surgery and subsequent catastrophic neurologic injuries resulting from epidural haematoma [ 3 – 5 ]. In addition, epidural analgesia is independently associated with an increased use of blood transfusions and a longer hospital stay [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, its utilizationis limited by perioperative coagulation dysfunction, which is typical in the patients for liver surgery and subsequent catastrophic neurologic injuries resulting from epidural haematoma [ 3 – 5 ]. In addition, epidural analgesia is independently associated with an increased use of blood transfusions and a longer hospital stay [ 5 ]. Enhanced recovery following hepatectomy has gained attention even though there is limited evidence on the efficacy and effectiveness of existing analgesic techniques.…”

Section: Introductionmentioning

confidence: 99%

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The analgesic efficacy of subcostal transversus abdominis plane block with Mercedes incision

Guo

Pei³

et al. 2018

BMC Anesthesiol

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BackgroundConventional perioperative analgesic modalities (e.g. opioids, epidural analgesia) have their own drawbacks, which limit their clinical application. This study investigated the opioid-sparing effectsof the oblique subcostal transversus abdominis plane (OSTAP) blockade with ropivacaine for the patients undergoing open liver resection with a Mercedes incision.Methods126 patients who were scheduled for open liver resection were enrolled in this study. Patients were randomly assigned to receive bilateral ultrasound-guided OSTAPblocks with either 0.375% ropivacaine (groupT) or 0.9% isotonic saline (group C). Both groups also received intravenous patient-controlled analgesia and intravenous 40 mg parecoxib every 12 h for a total of 3 days. Preoperative and intraoperative parameters, plus intraoperative and postoperative cumulative sufentanil consumption, were recorded.Results70 patients were enrolled in the study finally. There were no significant differences between the two groups with respect to preoperative parameters, and surgical and anesthetic characteristics. The intraoperative sufentanil use, cumulative sufentanil consumption at 5 min after extubation, 2 h, 4 h,12 h and 24 h after operation in group T was significantly less than that in group C (P = 0.001, 0.001, 0.000, 0.000, 0.001 and 0.044, respectively). Compared with group C, postoperative NRS pain scores at rest were significantly lower at 2 h and 4 h postoperatively in group T (P = 0.04and 0.02, respectively); NRS scores at the time of coughing were also significantly lower in group T than in group C at all time points except 5 min after extubation (all P < 0.001). Furthermore, compared with group C, the number of intraoperative vasodilator use, the extubation time and the incidence of nausea was reduced in group T.ConclusionUltrasound-guided OSTAP block with ropivacaine can significantly decrease the perioperative cumulative dosage of analgesics and improve analgesic effect without obvious side effects for the patients who underwent an open liver resection with Mercedes incision when compared tothe ultrasound-guided OSTAP block with saline.Trial registrationThe study protocol was registered at http://www.chictr.org.cn (ChiCTR-TRC- 14004827) on February 19, 2014.

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“…The epidural analgesia display properly in conjunction with general anesthesia, has a low rate of complications, with significant improvements in the patient's clinical condition over time [40][41][42][43][44][45]. The other analgesic technique also considered among the highest standards of treatment of acute pain is intrathecal analgesia with morphine.…”

Section: Postoperative Analgesia Fast Track Erasmentioning

confidence: 99%

Anesthesia in Liver Resections: Review

Bonofiglio

2017

JACCOA

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Evaluation of Epidural Analgesia for Open Major Liver Resection Surgery from a us Inpatient Sample

Cited by 17 publications

References 34 publications

Donor Hepatectomy Surgery using Ketamine to Compliment Analgesia and Reduce Morbidity - a Retrospective Chart Review Investigation

Donor Hepatectomy Surgery using Ketamine to Compliment Analgesia and Reduce Morbidity - a Retrospective Chart Review Investigation

The analgesic efficacy of subcostal transversus abdominis plane block with Mercedes incision

Anesthesia in Liver Resections: Review

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