An alternative method of wound pain control following hepatic resection: a preliminary study

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Epidural analgesia is one of the best methods for the provision of postoperative pain relief in patients recovering from major upper abdominal operations [ 1 x 1 Rodgers, A., Walker, N., and Schug, S. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomized trials. BMJ. 2000; 321: 1493 Crossref | PubMed | Google Scholar See all References , 2 x 2 Andersen, G., Rasmussen, H., and Blemmer. Postoperative pain control by epidural analgesia after transabdominal surgery. Acta Anaesthesiol Scand. 2000; 44: 296–301 Crossref | PubMed | Scopus (26) | Google Scholar See all References , 3 x 3 Lui, S., Carpenter, R.L., and Neal, J.M. Epidural anaesthesia and analgesia. Their role in postoperative outcome. Anesthesiology. 1995; 82: 1474–1506 Crossref | PubMed | Scopus (816) | Google Scholar See all References , 4 x 4 Malvena, E. and Taylor, S. Postoperative pain control. Recent Advances in Surgery. 2002; 25: 25–35 Google Scholar See all References , 5 x 5 Jorgensen, H., Wetterslev, J., Moiniche, S., and Dahl, J.B. Epidural local anaesthetics versus opioid‐based analgesic regimens for postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery (Cochrane Review). Cochrane Library. 2003; : 4 Google Scholar See all References ]. Liver resections usually entail relatively large incisions and prolonged operation times, and routine epidural analgesia has been established as ‘best practice’ in the authors' unit for some 15 years. However, there have been studies questioning its efficacy [ 6 x 6 Peyton, P.J., Myles, P.S., Silbert, B.S., Rigg, J.A., Jamrozik, K., and Parsons, R. Perioperative epidural analgesia and outcome after abdominal surgery in high‐risk patients. Anesth Analg. 2003; 96: 548–554 PubMed | Google Scholar See all References 6 ]. Being an invasive technique, epidural analgesia also carries an inherent risk of several complications [ 2 x 2 Andersen, G., Rasmussen, H., and Blemmer. Postoperative pain control by epidural analgesia after transabdominal surgery. Acta Anaesthesiol Scand. 2000; 44: 296–301 Crossref | PubMed | Scopus (26) | Google Scholar See all References 2 , 4 x 4 Malvena, E. and Taylor, S. Postoperative pain control. Recent Advances in Surgery. 2002; 25: 25–35 Google Scholar See all References 4 ]: hypotension, bradycardia, immediate or delayed respiratory depression, urinary retention, dural puncture and, perhaps of most concern, haematoma and/or infection within the spinal canal [ 3 x 3 Lui, S., Carpenter, R.L., and Neal, J.M. Epidural anaesthesia and analgesia. Their role in postoperative outcome. Anesthesiology. 1995; 82: 1474–1506 Crossref | PubMed | Scopus (816) | Google Scholar See all References 3 , 7 x 7 Kaiser, A.M., Zollinger, A., and De Lorenzi, D. Prospective, randomised comparison of extrapleural versus epidural analgesia for post thoracotomy pain. Ann Thorac Surg. 1998; 66: 367–372 Abstract | Full Text | Full Text PDF | PubMed | Scopus (87) | Google Scholar See all References 7 ]. Major neurological damage, causing both sensory deficits (incidence 0–0.7%) and motor deficits (incidence 0.005–0.02%), is a rare but potentially catastrophic complication [ 8 x 8 Tanaka, K., Watanabe, R., Harada, T., and Dan, K. Extensive application of epidural anesthesia and analgesia in a University Hospital: incidence of complications related to technique. Reg Anaesth. 1993; 18: 34–38 Google Scholar See all References 8 , 9 x 9 Horlocker, T.T., McGreger, D.G., and Matsushige, D.K. A retrospective review of 4767 consecutive spinal anesthetics: central nervous system complications. Anesth Analg. 1997; 84: 578–584 PubMed | Google Scholar See all References 9 ]. Epidural analgesia may therefore be regarded as unacceptable by some patients and is contraindicated in others, particularly those who are anticoagulated. Furthermore, technical difficulty sometimes precludes the technique [ 7 x 7 Kaiser, A.M., Zollinger, A., and De Lorenzi, D. Prospective, randomised comparison of extrapleural versus epidural analgesia for post thoracotomy pain. Ann Thorac Surg. 1998; 66: 367–372 Abstract | Full Text | Full Text PDF | PubMed | Scopus (87) | Google Scholar See all References 7 ]. These concerns prompted us to evaluate an alternative method of postoperative pain relief for patients undergoing elective major liver surgery.

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