Fast track liver resection: the effect of a comprehensive care package and analgesia with single dose intrathecal morphine with gabapentin or continuous epidural analgesia

Abstract

Background: A comprehensive care package for patients undergoing hepatectomy was developed with the aim of minimal physiological disturbance in the peri-operative period. Peri-operative analgesia with few gastrointestinal effects and reduced requirement for intravenous (IV) fluid therapy was central to this plan.

Methods: Data on 100 consecutive patients managed with continuous epidural infusion (n = 50; bupivicaine 0.125% and fentanyl 2 microg/mL at 0.1 mL/kg/hr) or intrathecal morphine (n = 50; 300 microg in combination with oral gabapentin 1200 mg preoperatively and 400 mg bd postoperatively) was compared.

Results: The epidural and intrathecal morphine groups were equivalent in terms of patient demographics, procedures and complications. Patients receiving intrathecal morphine received less intra-operative IV fluids (median 1500 mL versus 2200 mL, P = .06), less postoperative IV fluids (median 1200 mL versus 4300 mL, P = .03) than patients receiving epidural infusion. Patients managed with intrathecal morphine established a normal dietary intake sooner (16 hours versus 20 hours, P = .05) and had shorter hospital stays than those managed with epidural infusions (4.7 +/- 0.9 days versus 6.8 +/- 1.2 days, P = .02).

Conclusions: Single dose intrathecal morphine is a safe and effective means of providing peri-operative analgesia. Patients managed with intrathecal morphine have reduced peri-operative physiological disturbance and return home within a few days of hepatic resection.

Figure 1

Median daily change in patient in grams in the postoperative period in patient patients managed with intrathecal morphine or epidural anesthesia (*P < .05 with respect to intrathecal morphine group).

Figure 2

Median daily requirement of oral opiate (mg) in the postoperative period in patients managed with intrathecal morphine or epidural anesthesia (*P < .05 with respect to intrathecal morphine group).