Rotational Thrombo Elastometry and Standard Coagulation Tests for Hepatic Patients undergoing Major Liver Resection

Bedawy, Ahmed A; Fayed, Nirmeen A.; Morad, Wesam; Madany, Said; Nematalah, Fawzy; Yassen, Khaled

doi:10.4172/2155-6148.1000243

Cited by 4 publications

(4 citation statements)

References 21 publications

(25 reference statements)

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“…The use of anterior abdominal wall blocks as an alternative to the thoracic epidurals widely used in healthy liver patients was mainly suggested due to the expected coagulation changes (prolonged INR) which can be of special concern for patients with cirrhotic livers undergoing liver surgery. [3]…”

Section: Discussionmentioning

confidence: 99%

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Intravenous patient-controlled fentanyl with and without transversus abdominis plane block in cirrhotic patients post liver resection

Eldin¹,

Mahmoud²,

Hassan³

et al. 2014

LRA

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BackgroundCoagulation changes can complicate liver resection, particularly in patients with cirrhosis. The aim of this prospective hospital-based comparative study was to compare the postoperative analgesic efficacy of intravenous fentanyl patient-controlled analgesia (IVPCA) with and without transversus abdominis plane (TAP) block.MethodsFifty patients with Child’s A cirrhosis undergoing liver resection were randomly divided into two groups for postoperative analgesia, ie, an IVPCA group receiving a 10 μg/mL fentanyl bolus of 15 μg with a 10-minute lockout and a maximum hourly dose of 90 μg, and an IVPCA + TAP group that additionally received TAP block (15 mL of 0.375% bupivacaine) on both sides via a posterior approach with ultrasound guidance before skin incision. Postoperatively, bolus injections of bupivacaine 0.375% were given every 8 hours through a TAP catheter inserted by the surgeon in the open space during closure of the inverted L-shaped right subcostal with midline extension (subcostal approach) guided by the visual analog scale score (<3, 5 mL; 3 to <6, 10 mL; 6–10, 15–20 mL) according to weight (maximum 2 mg/kg). The top-up dosage of local anesthetic could be omitted if the patient was not in pain. Coagulation was monitored using standard coagulation tests.ResultsAge, weight, and sex were comparable between the groups (P>0.05). The visual analog scale score was significantly lower at 12, 18, 24, 48, and 72 hours (P<0.01) in IVPCA + TAP group. The Ramsay sedation score was lower only after 72 hours in the IVPCA + TAP group when compared with the IVPCA group (1.57±0.74 versus 2.2±0.41, respectively, P<0.01). Heart rate, systolic blood pressure, and fentanyl consumption were lower in the IVPCA + TAP group at 24, 48, and 72 hours (P<0.05). Intensive care unit stays were significantly shorter with TAP (2.61±0.74 days versus 4.35±0.79 days, P<0.01). Prothrombin time and International Normalized Ratio indicated temporary hypocoagulability in both groups.ConclusionCombining TAP with IVPCA improved postoperative pain management and reduced fentanyl consumption, with a shorter stay in intensive care. TAP block can be included as part of a balanced multimodal postoperative pain regimen.

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Section: Discussionmentioning

confidence: 99%

“…[2] Epidural analgesia in view of expected coagulopathy can increase risk of epidural hematoma. [345]…”

Section: Introductionmentioning

confidence: 99%

Intravenous patient-controlled fentanyl with and without transversus abdominis plane block in cirrhotic patients post liver resection

Eldin¹,

Mahmoud²,

Hassan³

et al. 2014

LRA

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“…It affects liver function, especially in cirrhotic patients with loss of functional hepatocytes. 1 Epidural analgesia has shown decreased pain scores and side effects compared to systemic intravenous analgesics following open abdominal surgery. However, complications of epidural analgesia include a varying incidence of post-dural puncture headache, local anesthetic systemic toxicity, spinal hematoma, abscess, and hypotension which should be considered.…”

Section: Introductionmentioning

confidence: 99%

Erector Spinae Block with Opioid Free Anesthesia in Cirrhotic Patients Undergoing Hepatic Resection: A Randomized Controlled Trial

MA¹,

MK²,

ML³

et al. 2022

LRA

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Background Hepatic resection is a major abdominal surgery with challenging pain management. We aimed to investigate the effect of erector spinae plane block (ESPB) with opioid free anesthesia (OFA) in cirrhotic patients scheduled for liver resection on perioperative pain management in terms of hemodynamic stability. Secondarily, we assessed time to first request for analgesia and perioperative fentanyl consumption, nausea and vomiting within 24 hours after surgery. Methods Forty patients were randomized to block group (n = 20): OFA with ESPB and conventional group (n = 20): conventional balanced anesthesia with opioids (OFA associated non-opioid drugs [dexmedetomidine, magnesium sulfate, xylocaine, and acetaminophen] and ESPB). Bilateral ESP block was done with ultrasound guidance at the level of thoracic vertebrae T 6–7, the local anesthetic dose was 20 mL Bupivacaine 0.25% with adjuvant dexmedetomidine (0.5 µg/kg) on each side. We monitored hemodynamic stability as the primary endpoint (heart rate, mean arterial blood pressure, and cardiac output). Results Bilateral ESPB offered somatic and visceral analgesia for hepatic resection patients with no intraoperative fentanyl required. Postoperatively, the block group with dexmedetomidine adjuvant to the local anesthesia drugs showed delay in the first request for analgesia ( p = 0.092) and decreased fentanyl requirement ( p < 0.001), so no patient in the ESP group suffered from postoperative nausea and vomiting compared to 50% in the conventional group ( p < 0.001). Conclusion Bilateral ESP block with OFA is an effective approach for intra- and postoperative analgesia in cirrhotic patients undergoing liver resection.

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“…In Egypt, between 1993 and 2002, there was an almost twofold increase in HCC amongst chronic liver patients [3]. Liver resection improves overall survival in patients with small, non-invasive and non-metastatic tumors [3,4], but this surgery may be followed by clinical or subclinical hepatocellular derangements, metabolic, hemodynamic, coagulation and electrolyte changes due the temporary liver dysfunction frequently encountered in the immediate postoperative period [5][6][7][8] the anaesthetic technique and management should take this in consideration. Few studies were designed to address this issue in cirrhotic patients with use of the minimal invasive transoesophageal Doppler to monitor these perioperative haemodynamic changes [5].…”

Section: Introductionmentioning

confidence: 99%

Effect of Target-Controlled Infusion of Propofol-Fentanyl versus Desflurane in Cirrhotic Patients Undergoing Major Hepatic Resection with Transoesophageal Doppler Monitoring A Randomized Control Study

Yassen¹,

Safty²,

Abdullah³

et al. 2014

J Anesth Clin Res

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Background and aim: The choice of anaesthetic agents is important for cirrhotics undergoing liver resection. Aim is to compare Target Controlled Infusion (TCI) Propofol-Fentanyl versus Desflurane (Des) on recovery, hemodynamics monitored with Transoesophageal Doppler (TED), the effect on hepatocellular, kidney functions and economics. Patients and methods: Prospective randomized controlled study, 50 patients (Child A) divided equally. In (Des) group induction with fentanyl (1microgram/kg), propofol (2 mg/kg) and rocuronium (1 mg/kg) and maintenance with Desflurane. In (TCI) group the Propofol blood target concentration (Ct) for induction was set at 4 μg/min and Fentanyl infusion was set at 3 μg/kg for 30 seconds , 2 μg/kg/h for 30 min, 1.5 μg/kg/h from 31-150 min, and 1 μg/kg/h until 30 min before end. Both propofol and fentanyl maintained with Navigator pharmacokinetic software and Entropy guidance. TED, urinary micro albuminurea (microalb), blood Glutathione-S-transferase (GST) were monitored. Results: Extubation time prolonged with TCI vs. Des (15.2 ± 2.6 vs. 9.7 ± 1.5 min respectively, (P<0.05). Postresection systemic vascular resistance (SVR) decreased significantly in both groups, but was better preserved with Des vs. TCI (836 ± 8 vs. 779 ± 36 dyn.sec.cm-5, P<0.01), this was reflected in higher mean blood pressure and stroke volumes (91 ± 3 vs. 81 ± 5 mmHg and 86 ± 3 ml vs. 78 ± 5 ml, respectively, P<0.01). Post-resection changes in GST and microalb were comparable between Des and TCI (GST: 441.0 ± 20.8 vs. 437.5 ± 22.2, IU/ml, P>0.05), (Microalb. 17.7 ± 2.5 vs. 18.64 ± 1.19, (µgm/ml) respectively, P>0.05). Des more economic than TCI (33.5 ± 8.2 vs. 69.1 ± 8.1 US Dollars), (P< 0.05) respectively during same surgical time and with comparable hemoglobin concentrations. Conclusion: Recovery was enhanced better with Desflurane. TED monitoring demonstrated a significant preservation of SVR and MABP post-resection with Des vs. TCI. Neither was superior to the other with respect to liver and kidney functions. Further studies on a larger scale are recommended. J o u rn al of A n e s th es ia & C li n ic a l Resea rc h

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Rotational Thrombo Elastometry and Standard Coagulation Tests for Hepatic Patients undergoing Major Liver Resection

Cited by 4 publications

References 21 publications

Intravenous patient-controlled fentanyl with and without transversus abdominis plane block in cirrhotic patients post liver resection

Intravenous patient-controlled fentanyl with and without transversus abdominis plane block in cirrhotic patients post liver resection

Erector Spinae Block with Opioid Free Anesthesia in Cirrhotic Patients Undergoing Hepatic Resection: A Randomized Controlled Trial

Effect of Target-Controlled Infusion of Propofol-Fentanyl versus Desflurane in Cirrhotic Patients Undergoing Major Hepatic Resection with Transoesophageal Doppler Monitoring A Randomized Control Study

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