ORIGINAL ARTICLE   Free access

Minerva Anestesiologica 2021 August;87(8):856-63

DOI: 10.23736/S0375-9393.21.15255-1

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Postoperative pain after intrathecal analgesia in laparoscopic liver resection: a retrospective chart review

April Y. LIU ¹, Thuva VANNIYASINGAM ^{2, 3}, Antonella TIDY ³, William YAO ¹, David SHIN ¹, Pablo E. SERRANO ⁴, Saeda NAIR ³ ✉

¹ Michael G. DeGroote School of Medicine, Hamilton, ON, Canada; ² Unit of Biostatistics, St. Joseph’s Healthcare, Hamilton, ON, Canada; ³ Department of Anesthesiology, Hamilton Health Sciences, Hamilton, ON, Canada; ⁴ Department of Surgery, Hamilton Health Sciences, Hamilton, ON, Canada

BACKGROUND: Intrathecal analgesia (IA) has been recommended by the enhanced recovery after surgery (ERAS) Society for laparoscopic colon resections; however, although IA is used in open liver resections, it has not been extensively studied in laparoscopic hepatobiliary surgery. This retrospective chart review was undertaken to explore postoperative pain within 48 hours among patients who underwent laparoscopic liver resections (LLR), receiving either IA with or without patient-controlled analgesia (IA±PCA) versus PCA alone.
METHODS: After ethics approval, charts were reviewed for adult patients who underwent LLR between January 2016 and April 2019, and had IA±PCA or PCA alone. Patients with any contraindication to IA with morphine, obstructive sleep apnea, body mass index >40 kg/m², history of chronic pain, and/or history of drug use were excluded. Descriptive statistics used to describe postoperative pain levels at 48 hours by treatment group for each pain outcome.
RESULTS: Of 111 patients identified, 79 patients were finally included; 22 patients had IA±PCA and 57 patients had PCA only. There were no statistically significant differences in baseline characteristics, use of non-opioid pain control, and postoperative complications between the two groups. IA use was associated with reduced postoperative opioid consumption (measured in oral morphine equivalents) compared to PCA alone (mean difference [95% confidence interval] -45.92 [-83.10 to -8.75]; P=0.016).
CONCLUSIONS: IA has the potential to decrease postoperative opioid use for patients undergoing LLR, and appears to be safe and effective in the setting of LLR. These findings are consistent with the ERAS Society recommendations for laparoscopic colorectal surgery.

KEY WORDS: Enhanced recovery after surgery; Injections, spinal; Analgesics, opioid; Laparoscopy; Liver