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Epidural analgesia in hepatic resection.

Publication ,  Journal Article
Page, A; Rostad, B; Staley, CA; Levy, JH; Park, J; Goodman, M; Sarmiento, JM; Galloway, J; Delman, KA; Kooby, DA
Published in: J Am Coll Surg
June 2008

BACKGROUND: Randomized trials show equivocal benefit of epidural analgesia (EA) for patients undergoing abdominal operations. Partial hepatectomy is often performed using low central venous pressure anesthesia to reduce intraoperative blood loss. We examined effects of pain management strategy on blood pressure, transfusion, and complications in patients undergoing hepatic resection with either EA or IV analgesia (IVA). STUDY DESIGN: Data on patients undergoing hepatectomy from 2001 to 2004 at Emory University Hospital were analyzed according to route of perioperative pain management. Patient and treatment factors were analyzed for associations with transfusion and morbidity. RESULTS: From 2001 through 2004, 367 patients underwent elective partial hepatectomy at Emory University Hospital. EA patients were more likely to be older, men, and with malignancy. There were no differences between the groups in extent of resection, operative time, blood loss, or starting hematocrit level. The EA group had lower mean arterial pressure in recovery (86.6+/-14.0 mmHg versus 94.5+/-13.2 mmHg, p < 0.001) and were more likely to be transfused with packed red cells during the hospital course (44.5% versus 27.9%, p < 0.001). On multivariate analysis, age greater than 65 years, American Society of Anesthesiologists grade>2, starting hematocrit<38%, operative time>300 minutes, blood loss>1 L, and use of EA were associated with increased numbers of patients receiving packed red blood cells. Complications and length of stay were similar for both groups. CONCLUSIONS: Epidural analgesia was independently associated with increased risk of packed red blood cell transfusion after hepatectomy. EA did not appear to minimize complications or shorten hospital stay. Caution should be exercised when considering EA use in hepatic resection.

Duke Scholars

Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

June 2008

Volume

206

Issue

6

Start / End Page

1184 / 1192

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Retrospective Studies
  • Postoperative Complications
  • Pain
  • Middle Aged
  • Male
  • Liver Diseases
  • Length of Stay
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Page, A., Rostad, B., Staley, C. A., Levy, J. H., Park, J., Goodman, M., … Kooby, D. A. (2008). Epidural analgesia in hepatic resection. J Am Coll Surg, 206(6), 1184–1192. https://doi.org/10.1016/j.jamcollsurg.2007.12.041
Page, Andrew, Bradley Rostad, Charles A. Staley, Jerold H. Levy, Jaemin Park, Michael Goodman, Juan M. Sarmiento, John Galloway, Keith A. Delman, and David A. Kooby. “Epidural analgesia in hepatic resection.J Am Coll Surg 206, no. 6 (June 2008): 1184–92. https://doi.org/10.1016/j.jamcollsurg.2007.12.041.
Page A, Rostad B, Staley CA, Levy JH, Park J, Goodman M, et al. Epidural analgesia in hepatic resection. J Am Coll Surg. 2008 Jun;206(6):1184–92.
Page, Andrew, et al. “Epidural analgesia in hepatic resection.J Am Coll Surg, vol. 206, no. 6, June 2008, pp. 1184–92. Pubmed, doi:10.1016/j.jamcollsurg.2007.12.041.
Page A, Rostad B, Staley CA, Levy JH, Park J, Goodman M, Sarmiento JM, Galloway J, Delman KA, Kooby DA. Epidural analgesia in hepatic resection. J Am Coll Surg. 2008 Jun;206(6):1184–1192.
Journal cover image

Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

June 2008

Volume

206

Issue

6

Start / End Page

1184 / 1192

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Retrospective Studies
  • Postoperative Complications
  • Pain
  • Middle Aged
  • Male
  • Liver Diseases
  • Length of Stay
  • Humans