Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 18, 2016; 8(26): 1097-1104
Published online Sep 18, 2016. doi: 10.4254/wjh.v8.i26.1097
Role of epidural anesthesia in a fast track liver resection protocol for cirrhotic patients - results after three years of practice
Antonio Siniscalchi, Lorenzo Gamberini, Tommaso Bardi, Cristiana Laici, Elisa Gamberini, Letizia Francorsi, Stefano Faenza
Antonio Siniscalchi, Lorenzo Gamberini, Tommaso Bardi, Cristiana Laici, Elisa Gamberini, Letizia Francorsi, Stefano Faenza, Division of Anesthesiology, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
Author contributions: All the authors contributed to this manuscript.
Institutional review board statement: Approved by the Policlinico S. Orsola Malpighi review board.
Informed consent statement: Approved by the Policlinico S. Orsola Malpighi review board.
Conflict-of-interest statement: The authors of this study certify that they have no affiliations with, or involvement in any organization or entity with any financial or non-financial interest, relating to the subject matter or the materials discussed in this manuscript. This study was fully supported by the Department of Anesthesiology of the University of Bologna.
Data sharing statement: No data were created so no data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Antonio Siniscalchi, MD, Division of Anesthesiology, Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. sinianest@libero.it
Telephone: +39-05-12143440
Received: May 8, 2016
Peer-review started: May 8, 2016
First decision: June 13, 2016
Revised: June 22, 2016
Accepted: August 11, 2016
Article in press: August 15, 2016
Published online: September 18, 2016
Processing time: 129 Days and 14.9 Hours
Abstract
AIM

To evaluate the potential benefits and risks of the use of epidural anaesthesia within an enhanced recovery protocol in this specific subpopulation.

METHODS

A retrospective review was conducted, including all cirrhotic patients who underwent open liver resection between January 2013 and December 2015 at Bologna University Hospital. Patients with an abnormal coagulation profile contraindicating the placement of an epidural catheter were excluded from the analysis. The control group was composed by patients refusing epidural anaesthesia.

RESULTS

Of the 183 cirrhotic patients undergoing open liver resections, 57 had contraindications to the placement of an epidural catheter; of the remaining 126, 86 patients received general anaesthesia and 40 combined anaesthesia. The two groups presented homogeneous characteristics. Intraoperatively the metabolic data did not differ between the two groups, whilst the epidural group had a lower mean arterial pressure (P = 0.041) and received more colloid infusions (P = 0.007). Postoperative liver and kidney function did not differ significantly. Length of mechanical ventilation (P = 0.003) and hospital stay (P = 0.032) were significantly lower in the epidural group. No complications related to the epidural catheter placement or removal was recorded.

CONCLUSION

The use of Epidural Anaesthesia within a fast track protocol for cirrhotic patients undergoing liver resections had a positive impact on the patient’s outcomes and comfort as demonstrated by a significantly lower length of mechanical ventilation and hospital stay in the epidural group. The technique appears to be safely manageable in this fragile population even though these results need confirmation in larger studies.

Keywords: Anesthesia; Postoperative care; Analgesia; Epidural; Postoperative; Liver cirrhosis; Liver function tests; Complication

Core tip: This retrospective study evaluates the potential benefits and risks of the use of epidural anaesthesia within an enhanced recovery protocol in the subpopulation of cirrhotic patients undergoing liver resection. We included all cirrhotic patients who underwent open liver resection between January 2013 and December 2015 at our Unit. The study included 126 cirrhotic patients, 86 patients received general anaesthesia and 40 combined anaesthesia. The two groups presented homogeneous characteristics. The epidural group had a lower intraoperative mean arterial pressure (P = 0.041) and received more colloid infusions (P = 0.007). Postoperative liver and kidney function did not differ significantly. Length of mechanical ventilation (P = 0.003) and hospital stay were significantly lower (P = 0.032) in the epidural group. No complications related to the epidural catheter management were recorded.