None listed
Conditions
Brief summary
In patients receiving hepato-biliary surgeries, postoperative pain control is of utmost importance in the process of recovery. The golden standard for post-operative pain relief for the open liver surgery is still debated due to inadequate available data, but optimal postoperative pain management is necessary for early mobilization and enhanced respiratory function. Several analgesia managements widely have been used and discussed, including intravenous patient-controlled analgesia (IV-PCA), anterior abdominal wall nerve blocks (NBs) and thoracic epidural analgesia (TEA). TEA is thought to be excellent in pain control, as it provides opioid free postoperative analgesia with fewer respiratory complications; however, it is long criticized for its potentially severe complications such as hypotension, epidural hematoma and infection, coagulopathy, a significant failure rate (20-30%) and possible post-operative organ dysfunction. When TEA is contraindicated or inappropriate, IV-PCA represents an alternative with equivalent post-operative pain control. However, IV-PCA is often associated with adverse drug events (ADEs) related to opioid including nausea, vomiting, urinary retention, delayed return of bowel function, over-sedation, respiratory depression and exacerbation of hepatic encephalopathy. Recently, regional NBs of the anterior abdominal wall, for example, subcostal transversus abdominis plane (TAP) and rectus sheath (RS) blocks, appear to play a role in the multimodal analgesia regimens. These blocks can further provide postoperative analgesia, decrease opioid requirement, reduce the incidence of ADEs and allow patients to breathe and cough more comfortably, altogether may shorten the length of hospital stay and improve the satisfaction of the patients.We hypothesized that IV-PCA + NBs may be non-inferior alternative to patient controlled epidural analgesia (PCEA) in postoperative recovery. We compared three groups of patients using IV-PCA only, IV-PCA + IV-PCA+ NBs and PCEA. Outcomes included total morphine consumption and numerical rating scale (NRS) at rest and on movement over the first three postoperative days, time to remove nasogastric tube, urinary catheter, time to commence on fluid and soft diet and length of hospital stay.
Interventions
From January 2015 to December 2019, patients who received open liver surgery would receive three different types of analgesic modalities to control postoperative pain, namely intravenous patient controlled analgesia (IV-PCA) only, IV-PCA + nerve blocks and patient controlled epidural analgesia (PCEA) for 3 days. Over the three day period, PCA infusion and bolus dose would be adjusted according to patients' pain level and side effects daily and as requested by patient. The total opioid requiremen
From January 2015 to December 2019, patients who received open liver surgery would receive three different types of analgesic modalities to control postoperative pain, namely intravenous patient controlled analgesia (IV-PCA) only, IV-PCA + nerve blocks and patient controlled epidural analgesia (PCEA) for 3 days. Over the three day period, PCA infusion and bolus dose would be adjusted according to patients' pain level and side effects daily and as requested by patient. The total opioid requirement wouuld be recorded at the end of day 3. Opioid-related side effects, removal of nasogastric tube and urinary catheter, initiation of bowel movement and the length of hospital stay would also be recorded before patient discharge.
Sponsors
Chang Gung Memorial Hospital, Linkou
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
We acquired data from CGMH Pain Service database that included patient demographics, diagnosis of disease, surgical procedures, medication and postoperative adverse effects. From January 2015 to December 2019
Exclusion criteria
Laparoscopic liver surgeries
Outcome results
None listed