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. 2015 May;9(2):78-85.
doi: 10.1177/2049463714525140.

Epidural analgesia provides effective pain relief in patients undergoing open liver surgery

Senthil Ganapathi  1 , Gemma Roberts  2 , Susan Mogford  2 , Barbara Bahlmann  3 , Bazil Ateleanu  3 , Nagappan Kumar  1
Affiliations

Epidural analgesia provides effective pain relief in patients undergoing open liver surgery

Senthil Ganapathi et al. Br J Pain. 2015 May.

Abstract

Background: Epidural analgesia has been the reference standard for the provision of post-operative pain relief in patients recovering from major upper abdominal operations, including liver resections. However, a failure rate of 20-32% has been reported.

Aim: The aim of the study was to analyse the success rates of epidural analgesia and the outcome in patients who underwent liver surgery.

Methods: We collected data from a prospectively maintained database of 70 patients who underwent open liver surgery by a bilateral subcostal incision during a period of 20 months (February 2009 to September 2010). Anaesthetic consultants with expertise in anaesthesia for liver surgery performed the epidural catheter placement. A dedicated pain team assessed the post-operative pain scores on moving or coughing using the Verbal Descriptor Scale. The outcome was measured in terms of epidural success rates, pain scores, post-operative chest infection and length of hospital stay.

Results: The study group included 43 males and 27 females. The indication for resection was liver secondaries (70%), primary tumours (19%) and benign disease (11%). While major (≥3 segments) and minor resections (≤ 2 segments) were performed in 44% and 47% respectively, 9% of patients were inoperable. Epidural analgesia was successful in 64 patients (91%). Bacterial colonisation of epidural tip was noticed in two patients. However, no neurological complications were encountered. Five patients (7%) had radiologically confirmed chest infection. Four patients (6%) developed wound infection. One patient died due to liver failure following extended right hepatectomy and cholecystectomy for gall bladder cancer. The median length of stay was 6 days (3-27 days). The extent of liver resection (p = 0.026) and post-operative chest infection (p = 0.012) had a significant influence on the length of stay.

Conclusion: Our experience shows that epidural analgesia is safe and effective in providing adequate pain relief following open liver surgery.

Keywords: Epidural analgesia; acute pain; drug therapy; liver surgery; prevention and control.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Clustered bar chart illustrating the frequency (number of patients) of pain scores in each of the post-operative days. OD: operative day; POD: post-operative day.
Figure 2.
Figure 2.
The length of stay was significantly higher in patients who had major liver resection (p = 0.026).
Figure 3.
Figure 3.
The length of stay was significantly higher in patients who had a post-operative chest infection (p = 0.012).
See this image and copyright information in PMC

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