Prevalence and Risk Factors Predisposing to Coagulopathy in Patients Receiving Epidural Analgesia for Hepatic Surgery

Abstract

A high prevalence of hemostatic abnormalities in patients undergoing major hepatic resection while receiving epidural analgesia occurred. Important considerations may include discussion with the surgical team, measuring coagulation, and heightened clinical monitoring in the postoperative period.

Abnormal coagulation profile after hepatic resection: the effect of chronic hepatic disease and implications for epidural analgesia

“…Most studies to date on changes in the perioperative coagulation profile during hepatic surgery and epidural analgesia have not reported on chronic hepatic disease, defined as hepatic diseases of greater than 6 months' duration [5][6][7][8][9], or are limited by patient populations being restricted to healthy donors for donor hepatectomies [10][11][12][13]. However, patients with chronic hepatic diseases frequently require hepatic surgery, and hence are subject to the risks of abnormal postoperative coagulation profiles on epidural analgesia.…”

Epidural anaesthesia and analgesia for liver resection

“…Following hepatic resection, haemostatic disorders do occur, despite completely normal pre-operative coagulation function, and this may increase the risk of epidural haematoma [6,9]. It is controversial as to whether the benefits of thoracic epidural anaesthesia and analgesia, including excellent analgesia, decreased incidence of pulmonary complications and reduced duration of ileus, outweigh its potential risks such as epidural haematoma and increased administration of intravenous fluids [7,[10][11][12][13]. This review focuses on the safety and analgesic efficacy of the use of this technique in patients undergoing liver resection and also discusses the risk-benefit ratio of its use in the context of accelerated and enhanced recovery programmes.…”

“…Although thoracic epidural anaesthesia and analgesia are commonly used for liver resection [3][4][5][6], there are concerns over its safety in this specific patient population. Complications associated with epidural catheters are uncommon, but include epidural haematomas, epidural abscesses or spinal cord injury [7,8]. Following hepatic resection, haemostatic disorders do occur, despite completely normal pre-operative coagulation function, and this may increase the risk of epidural haematoma [6,9].…”

Grading of Peripheral Cytopenias Caused by Nonalcoholic Cirrhotic Portal Hypertension and Its Clinical Significance

“…Mastuura et al [12]. suggested that a high postoperative PLT count was also a risk factor for decreased survival, and therefore the patient should be monitored for a high PLT count postoperatively [13,14] and proper treatment should be administrated when necessary.…”