Siniscalchi A, Gamberini L, Bardi T, Laici C, Gamberini E, Francorsi L, Faenza S. Role of epidural anesthesia in a fast track liver resection protocol for cirrhotic patients - results after three years of practice. World J Hepatol 2016; 8(26): 1097-1104 [PMID: 27660677 DOI: 10.4254/wjh.v8.i26.1097]
Corresponding Author of This Article
Antonio Siniscalchi, MD, Division of Anesthesiology, Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. sinianest@libero.it
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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ICU admission for at least the first post-operative night (or on POD 0)
Maintenance fluids discontinued on POD 3
Nasogastric probe removal on POD 1
Liquid diet on POD 1
Regular diet on POD 3
Urinary catheter discontinued on POD 3
Drains removal on POD 3
Ambulation on POD 3
Discharge criteria: Liver and kidney function tests compatible with preoperative data or decreasing, able to tolerate food intake, able to ambulate, good pain control (NRS < 3)
Table 2 Preoperative data
Group no epidural (n = 86)
Group epidural (n = 40)
P
Sex male (%)
69 (80.2%)
30 (75%)
0.655
Age (yr)
63.28 ± 11.38
62.8 ± 11.92
0.832
BMI
26.65 ± 4.36
25.23 ± 5.50
0.155
Cirrhosis etiology
HBV
19
10
0.947
HCV
49
27
0.434
Alcohol
9
2
0.501
Other
13
3
0.341
Type of resection
Major
19
12
0.461
Minor
67
28
Preoperative data
AST (UI/L)
50.8 ± 47.4
46.9 ± 29.1
0.586
ALT(UI/L)
47.4 ± 43.1
52.3 ± 38.5
0.541
Bilirubin (mg/dL)
0.80 ± 0.43
0.77 ± 0.40
0.710
INR
1.14 ± 0.12
1.10 ± 0.79
0.092
Creatinine (mg/dL)
1.08 ± 1.24
0.87 ± 0.26
0.164
Urea (mg/dL)
37.25 ± 13.74
36.84 ± 11.79
0.867
Platelet count
180134 ± 83856
211079 ± 94262
0.088
Table 3 Intraoperative data
Group no epidural (n = 86)
Group epidural (n = 40)
P
Hemodynamic parameters
MAP
Baseline
94.4 ± 12
89.5 ± 11.8
0.035
(mmHg)
Post-resection
77.3 ± 16.9
71.2 ± 9.7
0.041
(P = 0.004)
End of surgery
74.9 ± 10.7
74.9 ± 10.7
0.048
CVP
Baseline
8.26 ± 3.4
8.92 ± 3.15
0.323
(mmHg)
Post-resection
6.0 ± 3.25
5.76 ± 3.13
0.704
(P = 0.991)
End of surgery
7.35 ± 3.13
6.92 ± 2.57
0.466
Metabolic parameters
pH
Baseline
7.44 ± 0.043
7.44 ± 0.055
0.717
(P = 0.627)
Post-resection
7.40 ± 0.053
7.39 ± 0.053
0.608
End of surgery
7.38 ± 0.573
7.39 ± 0.062
0.258
Lac (mmol/L)
Baseline
2.07 ± 3.15
1.98 ± 3.11
0.925
(P = 0.894)
Post-resection
4.22 ± 6.11
4.68 ± 7.40
0.800
End of surgery
2.59 ± 2.20
2.62 ± 1.88
0.958
BE (mEq/L)
Baseline
1.27 ± 2.10
1.6 ± 1.94
0.563
(P = 0.343)
Post-resection
-1.93 ± 2.37
-1.31 ± 2.61
0.354
End of surgery
-2.72 ± 2.88
-2.56 ± 2.92
0.499
Other data
Lenght of surgery (min)
250.4 ± 93.48
267.6 ± 88.97
0.326
Hypotension duration (min)
2.28 ± 4.52
5.43 ± 6.68
0.006
Cristalloids infusions (mL)
2768 ± 1213
2574 ± 1022
0.354
Colloids infusions (mL)
259 ± 320
428 ± 312
0.007
RBC transfusions (U)
0.06 ± 0.239
0.01 ± 0.304
0.470
Total diuresis (mL)
467 ± 376
552 ± 384
0.248
Table 4 Post-operative data
Group no epidural (n = 86)
Group epidural (n = 40)
P
Hepatic function tests
AST (UI/L)
POD 1
205 ± 141
238 ± 168
0.239
(P = 0.451)
POD 3
97 ± 66
96 ± 54
0.334
POD 7
49 ± 29
52 ± 26
0.636
ALT (UI/L)
POD 1
195 ± 161
229 ± 210
0.144
(P = 0.605)
POD 3
157 ± 126
157 ± 106
0.391
POD 7
67 ± 47
73 ± 40
0.884
Bilirubin (mg/dL)
POD 1
1.60 ± 1.0
1.60 ± 0.88
0.994
(P = 0.557)
POD 3
1.8 ± 1.05
1.57 ± 0.81
0.306
POD 7
1.38 ± 1.06
1.26 ± 1.31
0.636
INR
POD 1
1.34 ± 0.18
1.31 ± 0.20
0.593
(P = 0.544)
POD 3
1.31 ± 0.16
1.30 ± 0.25
0.899
POD 7
1.26 ± 0.14
1.12 ± 0.15
0.319
Platelet count
POD 1
163649 ± 78332
148015 ± 72007
0.647
(P = 0.532)
POD 3
148015 ± 72007
132275 ± 43514
0.277
POD 7
191073 ± 74978
187586 ± 63602
0.827
Kidney function tests
Creatinine (mg/dL)
POD 1
0.96 ± 0.87
0.87 ± 0.42
0.579
(P = 0.417)
POD 3
0.98 ± 1.04
0.79 ± 0.29
0.331
POD 7
0.96 ± 1.15
0.78 ± 0.28
0.410
Urea (mg/dL)
POD 1
33.37 ± 13.87
32.86 ± 12.17
0.866
(P = 0.315)
POD 3
38.0 ± 21.17
33.79 ± 14.27
0.332
POD 7
35.57 ± 20.13
29.76 ± 11.67
0.151
Table 5 Hospital length of stay and complications
Group no epidural (n = 86)
Group epidural (n = 40)
P
Post operative MV lenght (h)
7.34 ± 18.11
1.29 ± 1.74
0.003
ICU stay (d)
2.78 ± 2.35
2.43 ± 1.57
0.183
Total PO hospital stay (d)
11.49 ± 7.95
8.65 ± 3.26
0.032
AKIN (grade)
0
81
40
0.121
1
3
0
2
1
0
3
1
0
DINDO (grade)
1
30
15
0.262
2
19
9
3
10
1
4
0
0
5
0
0
Citation: Siniscalchi A, Gamberini L, Bardi T, Laici C, Gamberini E, Francorsi L, Faenza S. Role of epidural anesthesia in a fast track liver resection protocol for cirrhotic patients - results after three years of practice. World J Hepatol 2016; 8(26): 1097-1104