BACKGROUND: The aim of this prospective observational study was to compare peri/post-operative outcomes of thoracic epidural analgesia (TEA) versus intrathecal morphine and fentanyl patient-controlled analgesia (ITM+fPCA) for patients undergoing a hepatic resection (HR). METHOD: Patients undergoing elective, one-stage, open HR for benign and malignant liver lesions, receiving central neuraxial block as part of the anaesthetic, in a high-volume hepato-pancreato-biliary unit, were included in the study. The primary outcome measure was post-operative length of stay (LoS). RESULTS: A total of 73 patients (36 TEA and 37 ITM+fPCA) were included in the study. The median (IQR) post-operative LoS was 13 (11-15) and 11 (9-13) days in the TEA and ITM+fPCA groups, respectively (P = 0.011). There was significantly lower median intra-operative central venous pressure (P < 0.001) and blood loss (P = 0.017) in the TEA group, and a significant reduction in the time until mobilization (P < 0.001), post-operative intra-venous fluid/vasopressor requirement (P < 0.001/P = 0.004) in the ITM+fPCA group. Pain scores were lower at a clinically significant level 12 h post-operatively in the TEA group (P < 0.001); otherwise there were no differences out to day five. There were no differences in quality of recovery or postoperative morbidity/mortality between the two groups. CONCLUSION: ITM+fPCA provides acceptable post-operative outcomes for HR, but may also increase the incidence of intra-operative blood loss in comparison to TEA.
BACKGROUND: The aim of this prospective observational study was to compare peri/post-operative outcomes of thoracic epidural analgesia (TEA) versus intrathecal morphine and fentanylpatient-controlled analgesia (ITM+fPCA) for patients undergoing a hepatic resection (HR). METHOD:Patients undergoing elective, one-stage, open HR for benign and malignant liver lesions, receiving central neuraxial block as part of the anaesthetic, in a high-volume hepato-pancreato-biliary unit, were included in the study. The primary outcome measure was post-operative length of stay (LoS). RESULTS: A total of 73 patients (36 TEA and 37 ITM+fPCA) were included in the study. The median (IQR) post-operative LoS was 13 (11-15) and 11 (9-13) days in the TEA and ITM+fPCA groups, respectively (P = 0.011). There was significantly lower median intra-operative central venous pressure (P < 0.001) and blood loss (P = 0.017) in the TEA group, and a significant reduction in the time until mobilization (P < 0.001), post-operative intra-venous fluid/vasopressor requirement (P < 0.001/P = 0.004) in the ITM+fPCA group. Pain scores were lower at a clinically significant level 12 h post-operatively in the TEA group (P < 0.001); otherwise there were no differences out to day five. There were no differences in quality of recovery or postoperative morbidity/mortality between the two groups. CONCLUSION: ITM+fPCA provides acceptable post-operative outcomes for HR, but may also increase the incidence of intra-operative blood loss in comparison to TEA.
Authors: James S Tomlinson; William R Jarnagin; Ronald P DeMatteo; Yuman Fong; Peter Kornprat; Mithat Gonen; Nancy Kemeny; Murray F Brennan; Leslie H Blumgart; Michael D'Angelica Journal: J Clin Oncol Date: 2007-10-10 Impact factor: 44.544
Authors: Ramanathan Kasivisvanathan; Nima Abbassi-Ghadi; Andrew D M McLeod; Alex Oliver; Ravishankar Rao Baikady; Shaman Jhanji; Stephen Cone; Timothy Wigmore Journal: HPB (Oxford) Date: 2015-05-21 Impact factor: 3.647
Authors: Emmanuel Melloul; Martin Hübner; Michael Scott; Chris Snowden; James Prentis; Cornelis H C Dejong; O James Garden; Olivier Farges; Norihiro Kokudo; Jean-Nicolas Vauthey; Pierre-Alain Clavien; Nicolas Demartines Journal: World J Surg Date: 2016-10 Impact factor: 3.352
Authors: David Cosgrave; Marie Galligan; Era Soukhin; Victoria McMullan; Siobhan McGuinness; Anand Puttappa; Niamh Conlon; John Boylan; Rabia Hussain; Peter Doran; Alistair Nichol Journal: Trials Date: 2017-12-29 Impact factor: 2.279
Authors: Paul R Burchard; Alexa D Melucci; Olivia Lynch; Anthony Loria; Yatee A Dave; Myla Strawderman; Luke O Schoeniger; Eva Galka; Jacob Moalem; David C Linehan Journal: J Am Coll Surg Date: 2022-05-04 Impact factor: 6.532
Authors: Grzegorz Niewiński; Wojciech Figiel; Michał Grąt; Marta Dec; Marcin Morawski; Waldemar Patkowski; Krzysztof Zieniewicz Journal: World J Surg Date: 2020-07 Impact factor: 3.352