Effectiveness and Safety of Thoracic Epidural Analgesia in Liver Resection Surgery

Kaukab  Majeed; Azmat  Riaz; Ali Mazhar  Rizvi; Usman Eijaz  Malik; Muhammad Shoaib  Khan; Abid  Khan

doi:10.51253/pafmj.v76i4.9480

Authors

Kaukab Majeed Department of Anaesthesia, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Azmat Riaz Department of Anaesthesia, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Ali Mazhar Rizvi Department of Anaesthesia, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Usman Eijaz Malik Department of Anaesthesia, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Muhammad Shoaib Khan Department of HPB & Liver Transplant Surgery, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Abid Khan Department of Anaesthesia, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76i4.9480

Keywords:

Analgesia, Hepatic Resection, Post-operative Pain, Thoracic Epidural

Abstract

Objective: To study the effectiveness and complications of thoracic epidural analgesia in patients undergoing open liver resection surgery

Study Design: Prospective Observational Study.

Place and Duration of Study: Army Liver Transplant Unit, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Aug 19 to May 22.

Methodology: A total of 50 patients who had open liver resection surgery and received thoracic epidural analgesia for pain relief were included in the study. All patients were above 18 years of age. Patients who had abnormal coagulation were excluded from the study. The effectiveness of the epidural was assessed by measuring the numerical rating scale (NRS) in the post-operative period. Complications, including accidental removal and epidural haematoma, were noted.

Results: 48(96%) group subjects had adequate pain relief with no to mild pain in 7(13.7%), 15(29.4%), 38(74.5%) and 41(80.4%) patients on the 1st, 2nd, 3rd, and 4th post-operative day (POD), respectively, with a p-value <0.001. The frequency of moderate pain was recorded in 18(35.3%) patients in the first POD, 24(47.1%) patients in the second POD, 7(13.7%) patients in the third POD, and 9(17.60%) on fourth POD. The frequency of pain was severe in 25(49.0%),

Conclusion: Thoracic epidural analgesia is an efficient and safe modality of analgesia after liver resection.

Downloads

Download data is not yet available.

References

1. Dudek P, Zawadka M, Andruszkiewicz P, Gelo R, Pugliese F, Bilotta F. Postoperative Analgesia after Open Liver Surgery: Systematic Review of Clinical Evidence. J ClinMed 2021; 10(16): 3662-3664. https://doi.org/10.3390/jcm10163662

2. Ye P, Liao C, Chen S, Xue F, Zheng X, Wang D. Bilateral thoracic paravertebral block for robotic hepatectomy without hepatic portal occlusion for a cirrhosis patient: a case report. Front Oncol 2026; 15: 1684794. https://doi:10.3389/fonc.2025.1684794

3. Koul A, Pant D, Rudravaram S, Sood J. Thoracic epidural analgesia in donor hepatectomy: An analysis. Liver Transpl 2018; 24(2): 214-221. https://doi.org/10.1002/lt.24989

4. Qiao XF, Jia WD, Li YQ, Liv JG, Zhou H. Effectiveness of Parecoxib Sodium Combined with Transversus Abdominis Plane Block for Pain Management After Hepatectomy for Hepatocellular Carcinoma: A Prospective Controlled Study. Med Sci Monit 2019; 25(2): 1053-1060.

https://doi.org/10.12659/msm.912843

5. Savikko J, Ilmakunnas M, Mäkisalo H, Nordin A, Isoniemi H. Enhanced recovery protocol after liver resection. Br J Surg 2015; 102(12): 1526–1532. https://doi.org/10.1002/bjs.9912

6. Rouxel P, Beloeil H. Enhanced recovery after hepatectomy: a systematic review. Anaesth Crit Care Pain Med 2019; 38(1): 29–34. https://doi.org/10.1016/j.accpm.2018.05.003

7. Lai HF, Chau IY, Lei HJ, Chou SC, Hsia CY, Kao YC, et al. Postoperative fever after liver resection: Incidence, risk factors, and characteristics associated with febrile infectious complications. PLOS ONE 2022; 17(1): e0262113.

https://doi.org/10.1371/journal.pone.0262113

8. Elterman KG, Xiong Z. Coagulation profile changes and safety of epidural analgesia after hepatectomy: a retrospective study. J Anesth 2015; 29(3): 367–372.

https://doi.org/10.1007/s00540-014-1933-4

9. Ganapathi S, Roberts G, Mogford S, Bahlmann B, Ateleanu B, Kumar N. Epidural analgesia provides effective pain relief in patients undergoing open liver surgery. Br J Pain. 2015; 9(2): 78-85. https://doi: 10.1177/2049463714525140

10. Agarwal V, Divatia JV. Enhanced recovery after surgery in liver resection: current concepts and controversies. Korean J Anesthesiol 2019; 72(2): 119–129.

11. Qi S, Chen G, Cao P, Hu J, He G, Luo J. Safety and efficacy of enhanced recovery after surgery (ERAS) programs in patients undergoing hepatectomy: a prospective randomized controlled trial. J Clin Lab Anal 2018: 22434.

https://doi.org/10.1002/jcla.22434

12. Liang X, Ying H, Wang H, Xu H, Liu M, Zhou H. Enhanced recovery care versus traditional care after laparoscopic liver resections: a randomized controlled trial. Surg Endosc 2018; 32(6): 2746–2757. https://doi.org/10.1007/s00464-017-5973-3

13. Atalan HK, Gucyetmez B, Donmez R. Advantages of epidural analgesia on pulmonary functions in liver transplant donors. Transplant Proc 2017; 49(6): 1351–1356.

https://doi.org/10.1016/j.transproceed.2017.03.087

14. Bell R, Ward D, Jeffery J, Toogood GJ, Lodge JA, Rao K. A randomized controlled trial comparing epidural analgesia versus continuous local anesthetic infiltration via abdominal wound catheter in open liver resection. Ann Surg 2019; 269(3): 413–419. https://doi.org/10.1097/sla.0000000000002988

15. Hausken J, Fretland AA, Edwin B, Dagenborg VJ, Bjornelv GMW. Intravenous patient-controlled analgesia versus thoracic epidural analgesia after open liver surgery: a prospective, randomized, controlled, Noninferiority trial. Ann Surg 2019; 270(2): 193–199.

https://doi.org/10.1097/SLA.0000000000003209

16. De Gasperi A, Petrò L, Amici O, Scaffidi I, Molinari P, Barbaglio C, et al. Major liver resections, perioperative issues and posthepatectomy liver failure: A comprehensive update for the anesthesiologist. World J Crit Care Med 2024; 13(2): 92751.

https://doi.org/10.5492/wjccm.v13.i2.92751

17. Pianngarn I, Lapisatepun W, Kulpanun M, Chotirosniramit A, Junrungsee S, Lapisatepun W. The effectiveness and outcomes of epidural analgesia in patients undergoing open liver resection: a propensity score matching analysis. BMC Anesthesiol 2024; 24(1): 305.

https://doi:10.1186/s12871-024-02697-1

18. Jennifer Li, Mir-Masoud P, Elizaveta V, Peter K, Osborn J. Efficacy and Safety of Patient-controlled Analgesia Compared with Epidural Analgesia After Open Hepatic Resection. Ann Surg 2019; 270(2): 200-208.

https://doi.org/10.1097/sla.0000000000003274