Comparing epidural analgesia and ON-Q infiltrating catheters for pain management after hepatic resection

Pain control after hepatic resection presents unique challenges as subcostal incisions, rib retraction, and diaphragmatic irritation can lead to significant pain. Both epidural analgesia and ON-Q catheters have been used for postoperative pain management after hepatic surgery, but to our knowledge have not been directly compared.

The records of 143 patient between the ages 18 and 70 were reviewed who underwent hepatic resection by a single surgeon. Patients were categorized according to method of postoperative pain control. Average pain scores for both study groups were collected until POD#3.

Demographic data and the length of surgery were similar between the groups (all p>0.05). On the day of surgery and POD#1, average pain scores for the epidural group were lower than the ON-Q group (P<0.0001 and P=0.0008 respectively). There was no difference in pain scores on POD #2 (P=.2369) or POD #3 (P=0.2289).

Epidural analgesia provides superior pain control on the day of surgery and POD#1 when compared to On-Q catheter with IV PCA. There was no difference in pain scores on POD#2 or POD#3. Future prospective randomized trials comparing these analgesic methods will be required to further evaluate enhanced recovery after hepatic surgery.