engleski

Continous wound infusion versus epidural postoperative analgesia after liver resection in carcinoma patients

Background: Continuous wound infiltration (CWI) and epidural thoracic analgesia (ETA) are analgesic techniques commonly used in the multimodal management of postoperative pain after open abdominal surgery. The aim of this study was to evaluate the effectiveness in pain reduce and postoperative recovery of these techniques in patients scheduled for liver resection. Methods: The retrospective study included 29 patients, with liver resection performed due to metastases of colon carcinoma. The patients were divided into two groups depending on type of postoperative analgesia. Wound catheter group (WC) included patients that had received analgesia through multiorifice wound catheter placed below the fascia and thoracic epidural group (TEA) included that had received local anesthetic through a epidural catheter. Both analgesic regimes were continued for 48 hours postoperatively. All patients received a standard postoperative pain management protocol, including patient-controlled analgesia (PCA) morphine and intravenous diclofenac every 12h. Outcomes measured over 48 h after operation were Numerical Rating Score (NRS) et rest and coughing, morphine consumption, and side-effects (PONV) and time to bowel function recovery. Results and Conclusion: No significant difference in morphine consumption was observed between groups (p=0, 395). Pain managment efficacy was satisfactory (NRS <4) in both groups and we did not find significant differences in Numerical rating skale (NRS) between groups (p=0, 128). We did not observed statisticaly significant differece in incidence of postoperative nausea and vomiting (PONV).Time to recover the bowel function was significantly reduced in WC Group 85, 93 ±21, 02 h and in TEA Group 107, 64±20, 02 h (p=.0, 008).We conclude thatwound catheter infusion in liver surgery is simple, safe and even more effective alternative to epidural analgesia in multimodal protocol for postoperative analgesia after liver resection.

wound infusion; epidural postoperative analgesia; liver carcinoma

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