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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2011 July;77(7):671-9
Epidural analgesia and liver resection: postoperative coagulation disorders and epidural catheter removal
Stamenkovic D. M. 1, Jankovic Z. B. 1, Toogood G. J. 2, Lodge J. P. A. 2, Bellamy M. C. 1 ✉
1 Department of Anaesthesia, St James’s University Hospital, Leeds, UK;
2 Department of Transplant and Hepatobiliary Surgery, St James’s University Hospital, Leeds, UK
BACKGROUND: The aim of this study was to quantify the duration and severity of postoperative coagulopathy in order to establish the optimal time for epidural catheter removal.
METHODS: In a 2-year retrospective study, 140 consecutive patients underwent major liver resection.
RESULTS:Epidural catheters were present in 123 patients (87.9%). Resections were: 33 (26.8%) right hepatectomy (with or without left metastasectomy), 9 (7.3%) left hemihepatectomy (with or without right metastasectomy), 37 (30.1%) trisectionectomy (extended hemihepatectomy) and 44 (35.8%) non-anatomical metastasectomy. Surgery was quantified by segments resected (4 [range: 1-7]). Vascular inflow occlusion was used in 65.6%. Ischaemic time was 26.5 min (range: 0-104 min). Platelet count fell postoperatively and was lowest on day 2 (205±72 109 L-1). There was a significant increase in prothrombin time, activated partial thromboplastin time and International Normalised Ratio (INR) postoperatively, peaking on day 2 (21.5±5.6 s, 37.9±5.8 s and 1.9±0.5, respectively). Changes persisted beyond day 6. Epidural catheters were removed on day 5 (1-11), with a protocol criterion of INR <1.2. Actual INR on day 5 was 1.49±0.36.
CONCLUSION: Despite this, no epidural or spinal haematoma was recorded.