Randomized clinical trial of local infiltration plus patient-controlled opiate analgesia vs. epidural analgesia following liver resection surgery

Abstract

Local anaesthetic wound infiltration combined with patient-controlled opiate analgesia reduces the length of time required to fulfil criteria for discharge from hospital compared with epidural analgesia following open liver resection. Epidural analgesia provides superior analgesia, but does not confer benefits in terms of faster mobilization or recovery.

Attitudes of patients and care providers to enhanced recovery after surgery programs after major abdominal surgery

“…This reflects the controversy that surrounds routine epidural use [18]. The use of alternative analgesic modalities, such as intrathecal analgesia and continuous wound infiltration, has become increasingly popular [19,20]. The UK Department of Health's Enhanced Recovery Partnership Programme consensus opinion [21] has subsequently advocated less routine epidural use and increased alternative analgesic methods.…”

Fast-Track Programs for Liver Surgery: A Meta-Analysis

“…For example, a recommended thoracic epidural in FT programs during colorectal surgery might not be for liver surgery because epidurals might affect postoperative recovery. [46][47][48][49][50] Paracetamol were utilized as a usual analgesic in some FT programs, but it might induce liver damage and increase postoperative complications especially in major liver resection, thus we should discreetly use some anesthetic that may cause liver damage. 46,51 Compared with other operations, liver surgery has its own particularity.…”

Epidural Versus Paravertebral Nerve Block for Postoperative Analgesia in Patients Undergoing Open Liver Resection

“…4 Other alternatives to epidural include wound infiltration with local anesthetic, which, although less efficacious and shorter lasting than epidural, was associated with shorter hospital stay. 24 Subcostal TAP blocks provided analgesia equivalent to epidural per VRS scores, but necessitated higher opioid administration, and had a higher failure rate due to incomplete coverage. 3 A TAP/intercostal hybrid variant, placed intraoperatively by the surgeon, has also been described as providing reasonable analgesia, although this pilot study had no comparison group.…”