EPIDURAL ANESTHESIA AFTER MAJOR HEPATECTOMY: A SAFE ALTERNATIVE FOR POSTOPERATIVE PAIN MANAGEMENT
Katelyn Flick*, Thomas K. Maatman, Mazhar Soufi, Eugene P. Ceppa, Michael G. House, Attila Nakeeb, Nicholas J. Zyromski, Trang K. Nguyen, C. Max Schmidt
General Surgery , Indiana University, Indianapolis, IN
Introduction
Over the last decade there has been focus on enhanced recovery after surgery. In an effort to provide improved pain control and reduce opioid consumption there has been an increase in use of epidural anesthesia (EA). Studies have shown a reduction in length of stay (LOS) and postoperative complications in colorectal surgery and pancreas surgery. However, the benefits of its use in complex liver surgery are still not well described. This study hypothesized that EA in patients undergoing major hepatectomy is associated with decreased hospital LOS and perioperative morbidity.
Methods
A single-institution observational study of patients undergoing open major hepatectomy for any indication between January 2013 and December 2018 was performed using a prospective institutional database. Major hepatectomy was defined as resection of three or more Couinaud liver segments. Exclusion criteria included patients undergoing a concurrent operation or biliary reconstruction. Continuous data are reported as mean values with standard deviation and were compared using independent groups t-test. Categorical data are reported as number with percent and were compared using the chi-squared test.
Results
A total of 171 patients underwent open hepatectomy during the study period; 98 (57%) patients received an epidural (EA) and the remaining 73 (43%) patients did not (no EA). At baseline, patients were similar (P > 0.05) except for more preoperative steroid use and presence of a bleeding disorder in the no EA vs EA group, Table 1. Perioperative variables were comparable between groups with the exception of higher operative drain placement and model for end-stage liver disease in the group with no EA. Patients with EA had greater operative time, Table 1. Patients receiving an epidural had significantly lower rates of pneumonia (EA, 0%; no EA, 4%; P= 0.04). Decreased length of stay was observed in the EA group (EA, 6.5 days; no EA, 8.0 days; P= 0.02). 30-day readmission was significantly less in the EA group (EA, 4%; no EA, 8%; P= 0.01). Remaining outcomes did not vary significantly between groups (P>0.05), Table 2.
Conclusion
Epidural anesthesia is safe in patients undergoing open major hepatectomy. In this study of patients, epidural anesthesia was associated with lower rates of pneumonia, decreased length of stay, and fewer readmissions.
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