Enhanced Recovery via Peripheral Nerve Block for Open Hepatectomy

Area of Science:

• Hepatobiliary Surgery
• Surgical Protocols
• Pain Management

Background:

• Enhanced Recovery After Surgery (ERAS) protocols are widely adopted but understudied in hepatobiliary surgery.
• Limited data exists on ERAS implementation for open hepatectomy procedures.

Purpose of the Study:

• To evaluate the impact of standardized ERAS protocols on outcomes following open hepatectomy.
• To assess the effectiveness of replacing thoracic epidurals with transversus abdominis plane (TAP) blocks within an ERAS framework.

Main Methods:

• Retrospective cohort study comparing patients before and after ERAS implementation (January 2014-September 2016).
• Analysis of perioperative details, healthcare utilization, and pain scores (visual analog scale).
• Key outcomes measured: ICU admission, length of stay (LOS), costs, 30-day readmission, and uncontrolled pain rates.

Main Results:

• ERAS implementation was associated with significantly lower ICU admission rates (47% vs. 13%) and shorter LOS (median 5.3 vs. 4.3 days).
• Median costs were reduced by $3566, with no significant change in 30-day readmission rates (5% pre-ERAS, 4% post-ERAS).
• Uncontrolled pain rates decreased significantly after ERAS implementation through postoperative day 3 (41% vs. 23%).

Conclusions:

• Standardized ERAS protocols, utilizing TAP blocks for open hepatectomy, enhance the quality and cost-effectiveness of patient care.
• Evidence-based best practices, including ERAS, should be considered for all liver resection patients.