Epidural anesthesia and analgesia in liver resection: Safety and effectiveness

Esteve, N.; Ferrer, Ana; Sansaloni, C.; Mariscal, Marcial; Torres, María José; Mora, Carmen

doi:10.1016/j.redare.2016.11.005

Cited by 12 publications

(15 citation statements)

References 29 publications

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“…7 Such benefits for epidural anaesthesia in donors for LDLT have also been demonstrated in many studies. [8][9][10] On the other hand the use of TEA in LT recipients is a debatable issue due to coagulation profile derangements and bleeding tendency in patients with liver failure. 11,12 Li et al demonstrated significantly increased risk of major bleeding after invasive procedures in cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Anaesthesia for liver transplantation at King Hussein medical centre: an overview of 70 cases

et al. 2021

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Background: To review the indications, patients' demographics, and anaesthetic protocol and to analyze perioperative complications of liver transplantation surgery.Methods: Retrospective analysis of 70 cases of LT in the period between June 2004 and October 2020 at King Hussein medical centre. Preoperative factors such as patients' demographics, age, gender, etiology of hepatic pathology, laboratory investigations, model for end-stage liver disease scores, duration of surgery and type of liver donation were recorded. Intraoperative factors such as anaesthetic and surgical protocols, need of blood product transfusions and haemodynamic monitoring were analyzed. Postoperative tracking of patients' complications and outcomes was done.Results: 68 living donor and two cadaveric LT procedures. Male to female ratio was 2.9:1.The age of LT recipients ranged from 3 to 62 years with an average age of 38.45 years. Their body weights ranged from 13 to 100 kg with mean body weight of 67.03 kg. Most common indication was cryptogenic liver cirrhosis (21.4%), followed by cirrhosis due to viral hepatitis B (15.7%). Autoimmune hepatitis was an indication in 11.4% and hepatitis C liver cirrhosis in 10%. All living donors were closely related. Right hepatic lobe graft was used in 85.7% of transplantations. Average red cells concentrate (RCC) transfused (units) was 3.1±3.97 (mean±SD). Duration of surgery (hours) was 12.5±2.4 (mean±SD). Fast track LT with extubation in theatre was done in 37 LT recipients (52.9%). Readmission to operative theatre was needed in 5 recipients (7.14%). Most common long term complications were biliary leak (20%), biliary stenosis (14.2%) and recurrence of primary disease (12.9%).Conclusions: Transplantation from living donors was by far more common in our study population. Majority of recipients were male and cryptogenic liver cirrhosis was the most common indication. Right hepatic lobe graft was used mostly. Biliary leak was the most common postoperative complication. Surgical time duration and blood products transfusion decreased significantly over years since the start of LT program.

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Section: Discussionmentioning

confidence: 99%

Anaesthesia for liver transplantation at King Hussein medical centre: an overview of 70 cases

et al. 2021

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“…Patients undergoing extensive liver surgery experience dramatic somatic and visceral pain due to extended subcostal incision, rib retraction, as well as diaphragmatic and peritoneal irritation [16]. Despite the absence of a pre-operative contraindication for epidural placement, patients undergoing hepatic surgery are prone to the development of post-operative coagulopathy which could potentially pose a bleeding risk and delay removal of an epidural catheter [8,17]. Risk factors for the development of post-operative elevations in international normalized ratios following hepatic resection include small remnant liver volumes, decreased body mass index, and long duration of procedure [16].…”

Section: Discussionmentioning

confidence: 99%

“…Epidural analgesia confers benefits related to decreased pain scores and side effects compared to systemic intravenous analgesics following open abdominal surgery [6,7]. However epidural analgesia has been found non-superior to regional techniques, such the paravertebral block, in achieving patient satisfaction [6].…”

Section: Introductionmentioning

confidence: 99%

“…However epidural analgesia has been found non-superior to regional techniques, such the paravertebral block, in achieving patient satisfaction [6]. Complications of epidural analgesia include a varying incidence of post-dural puncture headache, local anesthetic systemic toxicity, spinal hematoma and abscess, hypotension, nausea and vomiting, and urinary retention [6,7]. Epidural catheter removal can be delayed following liver resection due to post-operative coagulopathy [7,8].…”

Section: Introductionmentioning

confidence: 99%

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Safe and Effective Use of Bilateral Erector Spinae Block in Patient Suffering from Post-operative Coagulopathy following Hepatectomy

Maddineni¹,

Maarouf

Johnson³

et al. 2020

Am J Case Rep

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Unusual clinical course Background:Regional nerve blocks ideally provide safe and effective post-operative pain control, decrease opiate requirements, and enhance recovery from intense pain following major thoracic, abdominal, and musculoskeletal surgeries. The erector spinae plane block, a recently described novel treatment for chronic neuropathic pain and acute pain after thoracic surgery, can be performed with in plane infiltration and placement of a continuous infusion catheter deep to the erector spinae muscle at the tip of the transverse process, resulting in diffusion of local anesthetic between vertebrae and the paravertebral space with sensory blockade of spinal nerves as well as sympathetic branches. Case Report:We describe the novel use of the erector spinae block for primary pain control and uncomplicated catheter removal in the setting of anticoagulation following a major hepatectomy for intrahepatic cholangiocarcinoma. The use of the erector spinae block in this context provided effective post-operative analgesia. Conclusions:Additional evidence from clinical trials will be helpful to evaluate the role of this relatively new block for perioperative analgesia.

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“…12 In Epidural analgesia is considered the gold standard to manage postoperative pain after major abdominal surgeries due to the possible superior analgesic effect. [14][15] However, unwanted complications and the possibility of a labor-intensive and non-functioning epidural catheter make epidural analgesia not an ideal analgesic method for hepatectomy. Large hepatectomy can lead to postoperative coagulopathy, 16 which was confirmed in our study.…”

Section: Baseline Informationmentioning

confidence: 99%

Efficacy and Safety of a Continuous Wound Catheter in Open Abdominal Partial Hepatectomy

Che

Lü

Pei

2017

Chinese Medical Sciences Journal

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Epidural anesthesia and analgesia in liver resection: Safety and effectiveness

Cited by 12 publications

References 29 publications

Anaesthesia for liver transplantation at King Hussein medical centre: an overview of 70 cases

Anaesthesia for liver transplantation at King Hussein medical centre: an overview of 70 cases

Safe and Effective Use of Bilateral Erector Spinae Block in Patient Suffering from Post-operative Coagulopathy following Hepatectomy

Efficacy and Safety of a Continuous Wound Catheter in Open Abdominal Partial Hepatectomy

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