Role of epidural anesthesia in a fast track liver resection protocol for cirrhotic patients-results after three years of practice

作     者：Antonio Siniscalchi Lorenzo Gamberini Tommaso Bardi Cristiana Laici Elisa Gamberini Letizia Francorsi Stefano Faenza 

作者机构：Division of AnesthesiologyAlma Mater Studiorum University of Bologna 

出 版 物：《World Journal of Hepatology》 (世界肝病学杂志（英文版）（电子版）)

年 卷 期：2016年第8卷第26期

页      面：1097-1104页

学科分类：1002[医学-临床医学] 100217[医学-麻醉学] 10[医学] 

基　　金：Department of Anesthesiology of the University of Bologna 

主　　题：Anesthesia Postoperative care Analgesia Epidural Postoperative Liver cirrhosis Liver function tests Complication 

摘      要：AIM To evaluate the potential benefits and risks of the use of epidural anaesthesia within an enhanced recovery protocol in this specific *** 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 *** 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 *** 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.