Epidural Anesthesia in Liver Surgery-A Propensity Score-Matched Analysis

Area of Science:

• Anesthesiology
• Surgical Oncology
• Hepatobiliary Surgery

Background:

• Liver resection is a major surgery with significant postoperative pain and potential complications.
• Effective pain management and improved patient outcomes are critical after hepatectomy.
• Epidural anesthesia (EA) is an option for regional analgesia, but its specific impact on liver surgery outcomes requires evaluation.

Purpose of the Study:

• To assess the impact of epidural anesthesia (EA) on postoperative pain, complications, and survival in patients undergoing liver resection.
• To evaluate the safety and efficacy of EA in the context of major abdominal surgery.

Main Methods:

• Secondary analysis of a prospective randomized controlled trial involving 110 propensity score-matched patients undergoing liver resection.
• Outcomes included pain intensity (Numeric Rating Scale), postoperative complications (Clavien-Dindo), length of hospital stay (LOS), and one-year survival.
• Statistical analyses utilized logistic mixed-effects models and a frailty model for survival comparison.

Main Results:

• Epidural anesthesia (EA) patients reported significantly less severe pain at rest (OR=0.06, P<0.001).
• One-year survival was markedly improved in the EA group (9.1% vs 30.9%, HR=0.32, P=0.031).
• No significant differences were observed in postoperative complications or length of hospital stay between groups. Earlier bowel function recovery was noted with EA.

Conclusions:

• Epidural anesthesia (EA) provides superior postoperative pain control and reduces mortality in liver resection patients.
• EA is a safe and effective anesthetic technique for liver surgery, without increasing adverse events or length of stay.
• The findings support the use of EA to enhance recovery and long-term survival following liver resection.