Jose M Soliz1, Rodolfo Gebhardt2, Lei Feng3, Wenli Dong4, Margaret Reich5, Steven Curley6. 1. M.D. Anderson Cancer Center, Department of anesthesiology and Perioperative Medicine, 1515 Holcombe Blvd. Unit 409, Houston, TX 77030, , , jsoliz@mdanderson.org. 2. M.D. Anderson Cancer Center, Department of Pain Medicine, 1515 Holcombe Blvd. Unit 409, Houston, TX 77030, (713) 563-5764 office, rgebhardt@mdanderson.org. 3. M.D. Anderson Cancer Center, Department of Biostatistics, 1515 Holcombe Blvd. Unit 1411, Houston, TX 77030, (713) 794-4169 office, leifeng@mdanderson.org. 4. M.D. Anderson Cancer Center, Department of Biostatistics, 1515 Holcombe Blvd. Unit 1411, Houston, TX 77030, (713) 563-4291, wdong@mdanderson.org. 5. U.T. Health Science Center-San Antonio, Medical School, 7703 Floyd Curl Drive, San Antonio, TX, USA 78229, 713-301-7831, reich.maggie@gmail.com. 6. M.D. Anderson Cancer Center, Department of Surgical Oncology, 1515 Holcombe Blvd. Unit 444, Houston, TX 77030, (713) 794-4957, scurley@mdanderson.org.
Abstract
BACKGROUND AND OBJECTIVES: Pain control after hepatic resection presents unique challenges as subcostal incisions, rib retraction, and diaphragmatic irritation can lead to significant pain. Both epidural analgesia and ON-Q catheters have been used for postoperative pain management after hepatic surgery, but to our knowledge have not been directly compared. METHODS: The records of 143 patient between the ages 18 and 70 were reviewed who underwent hepatic resection by a single surgeon. Patients were categorized according to method of postoperative pain control. Average pain scores for both study groups were collected until POD#3. RESULTS: Demographic data and the length of surgery were similar between the groups (all p>0.05). On the day of surgery and POD#1, average pain scores for the epidural group were lower than the ON-Q group (P<0.0001 and P=0.0008 respectively). There was no difference in pain scores on POD #2 (P=.2369) or POD #3 (P=0.2289). CONCLUSIONS: Epidural analgesia provides superior pain control on the day of surgery and POD#1 when compared to On-Q catheter with IV PCA. There was no difference in pain scores on POD#2 or POD#3. Future prospective randomized trials comparing these analgesic methods will be required to further evaluate enhanced recovery after hepatic surgery.
BACKGROUND AND OBJECTIVES:Pain control after hepatic resection presents unique challenges as subcostal incisions, rib retraction, and diaphragmatic irritation can lead to significant pain. Both epidural analgesia and ON-Q catheters have been used for postoperative pain management after hepatic surgery, but to our knowledge have not been directly compared. METHODS: The records of 143 patient between the ages 18 and 70 were reviewed who underwent hepatic resection by a single surgeon. Patients were categorized according to method of postoperative pain control. Average pain scores for both study groups were collected until POD#3. RESULTS: Demographic data and the length of surgery were similar between the groups (all p>0.05). On the day of surgery and POD#1, average pain scores for the epidural group were lower than the ON-Q group (P<0.0001 and P=0.0008 respectively). There was no difference in pain scores on POD #2 (P=.2369) or POD #3 (P=0.2289). CONCLUSIONS: Epidural analgesia provides superior pain control on the day of surgery and POD#1 when compared to On-Q catheter with IV PCA. There was no difference in pain scores on POD#2 or POD#3. Future prospective randomized trials comparing these analgesic methods will be required to further evaluate enhanced recovery after hepatic surgery.
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