Anesthesia Techniques, Cognitive Dysfunction, Epidural-general Anesthesia, Hepatectomy, Liver Cancer, Postoperative Pain
Conditions
Brief summary
To evaluate the effects of general anesthesia (GA) versus combined general and epidural anesthesia (GEA) on postoperative pain, cognitive dysfunction (POCD), hospital stay, and recovery quality in liver cancer patients undergoing hepatectomy. A retrospective analysis of 80 liver cancer patients was conducted, categorized by analgesic adequacy, pain recovery, and POCD incidence: adequate vs. inadequate analgesia (n=50 vs. n=30), favorable vs. delayed pain recovery (n=36 vs. n=44), and POCD vs. non-POCD (n=42 vs. n=38). Based on these results, a prospective study (April 2024-April 2025) enrolled patients scheduled for elective hepatectomy, assigned to the GA group (n=59) or GEA group (n=47). Primary outcomes included intraoperative analgesic consumption, postoperative VAS pain scores, MoCA cognitive scores, hospital stay length, and adverse event rates.
Detailed description
Compared to GA alone, combined epidural-general anesthesia provides better perioperative pain control, reduces POCD risk, shortens hospitalization, and enhances recovery. GEA is a preferable anesthetic approach for liver cancer surgery.
Interventions
DRUGGeneral Anesthesia (GA) group
In the General Anesthesia (GA) group (n = 59), patients received combined intravenous-inhalation general anesthesia. Anesthesia induction was performed using propofol and remifentanil, followed by maintenance with sevoflurane to ensure adequate anesthetic depth and hemodynamic stability throughout the procedure.
DRUGGeneral-Epidural Anesthesia (GEA) group
In the General-Epidural Anesthesia (GEA) group (n = 47), patients received the same general anesthesia protocol as the GA group, in addition to epidural anesthesia. An epidural catheter was placed preoperatively at the T7-T9 vertebral level using a midline approach under strict aseptic conditions. Following successful catheterization and confirmation of proper placement, a continuous intraoperative infusion of 0.25% ropivacaine was administered via the epidural route to provide segmental analgesia and reduce intraoperative opioid requirements.
Sponsors
Sir Run Run Shaw Hospital, Qingchun Campus, Zhejiang University School of Medicine,
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Inclusion Criteria: * Histologically or radiologically confirmed primary liver cancer (HCC or cholangiocarcinoma) * Scheduled for elective open or laparoscopic radical hepatectomy * Age 18-75 years * ASA Physical Status I-III * Child-Pugh class A or B liver function * Normal preoperative MoCA score (≥26) * Willing to participate and provide informed consent *
Exclusion criteria
* Severe cardiovascular, pulmonary or renal disease (ASA IV/V) * Chronic pain disorders or preoperative opioid use (\>3 months) * Known neurologic/psychiatric conditions (dementia, stroke, epilepsy) * Concurrent major procedures (e.g., vascular resection) * Intraoperative conversion to palliative surgery * Massive intraoperative hemorrhage (\>2000 mL) * Coagulopathy (INR \>1.5 or platelets \<50×10⁹/L) * Spinal abnormalities precluding epidural catheterization * Pregnancy or lactation * Allergy to local anesthetics or study medications
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Cognitive Dysfunction (POCD) | Baseline (preoperative), POD1 (24±4h), POD3 (72±6h) | Percentage of patients with: MoCA score \<26 at postoperative assessment OR ≥2-point decrease from preoperative baseline (Assessed using Montreal Cognitive Assessment, 30-point scale) |
| Postoperative Pain Intensity | 2h, 6h, 12h, 24h, 48h postoperatively | Mean pain scores measured by: Visual Analog Scale (VAS) 10cm scale (0=no pain, 10=worst pain) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Adverse Event Incidence | 0-72 hours postoperatively | Percentage of patients with: Nausea/vomiting Delirium (CAM-positive) Other complications |
| Hospital Length of Stay | Up to 30 days post-surgery | Duration from surgery end to discharge: Measured in days From electronic medical records |
| Intraoperative Opioid Consumption | Anesthesia induction to extubation | Total remifentanil dose administered: Measured in micrograms (μg) Recorded from anesthesia machine |
Other
| Measure | Time frame | Description |
|---|---|---|
| Intraoperative Analgesic Adequacy | Entire surgical duration | Percentage of patients with: Grade I (adequate) vs Grades II-IV (inadequate) analgesia (Per Supplementary Table S1 criteria) |
| Surgical Stress Correlation | Intraoperative period | Pearson correlation coefficients between: Anesthesia technique (GA/GEA) Blood loss (mL) Surgery duration (min) |
Countries
China
Outcome results
None listed