Regional Anesthesia and Acute Pain ManagementRegional Anesthesia and Acute Pain Management1993-65082687-1394Eco-Vector10796310.17816/RA107963Research ArticleEpidural blockade during liver transplantationZhikharevVasiliy A.<p>MD, Dr. Sci. (Med.)</p>Vasilii290873@mail.ruhttps://orcid.org/0000-0001-5147-5637BushuevAlexander S.Vasilii290873@mail.ruhttps://orcid.org/0000-0002-1427-4032KhasanovMovsar U.Vasilii290873@mail.ruhttps://orcid.org/0000-0002-3558-4283KoriachkinVictor A.<p>MD, Dr. Sci. (Med.), Professor</p>vakoryachkin@mail.ruhttps://orcid.org/0000-0002-3400-8989PorkhanovVladimir A.<p>MD, Dr. Sci. (Med.), Professor</p>Vasilii290873@mail.ruhttps://orcid.org/0000-0003-0572-1395Scientific Research Institution, Ochapovsky Regional Clinic Hospital N1St. Petersburg State Pediatric Medical UniversityKuban state medical university150920211542452561605202201062022Copyright © 2021, Eco-Vector2021<p><strong><em>AIM</em></strong><em>:</em> This study aimed to evaluate the efficacy and safety of epidural analgesia as a component of pain relief on orthotopic liver transplantation.</p>
<p><strong><em>MATERIALS AND METHODS</em></strong><em>:</em> Forty-five patients who underwent orthotopic liver transplantation were examined. Epidural and opioid analgesics were used as a component of pain relief in groups 1 (n=24) and 2 (n=21), respectively. The following parameters were evaluated: intensity of postoperative pain, time of patient activation, incidence of postoperative nausea and vomiting, time of onset of enteral nutrition, restoration of bowel function, incidence of postoperative acute respiratory failure, need for opioid analgesics, and length of stay in the intensive care unit (ICU).</p>
<p><strong><em>RESULTS</em></strong><em>: </em>Pain intensity and total postoperative need for tramadol and promedol were significantly lower in group 1 than in group 2. During the postoperative period, group 1 showed a decrease in postoperative nausea and vomiting, incidence of postoperative respiratory failure, and time spent in the ICU. No complications with the insertion and removal of the epidural catheter were observed.</p>
<p><strong><em>CONCLUSION</em></strong><em>: </em>The use of epidural blockade for liver transplantation significantly reduces the severity of pain syndrome, accelerates the recovery of bowel function, and shortens the length of ICU stay. The use of EA reduces the risk of PONV during the use of opioid analgesics and causes an early start of enteral nutrition. Therefore, epidural analgesics can be used as a component of pain relief in patients undergoing orthotopic liver transplantation.</p>orthotopic liver transplantationepidural analgesiapainортотопическая трансплантация печениэпидуральная анальгезияболь[European Association for the Study of the Liver. Electronic address eee. EASL Clinical Practice Guidelines: Liver transplantation. J Hepatol. 2016;64(2):433–485. doi: 10.1016/j.jhep.2015.10.006][Milan Z. Analgesia after liver transplantation. World J Hepatol. 2015;7(21):2331–2335. doi: 10.4254/wjh.v7.i21.2331][Aniskevich S, Pai SL. Fast track anesthesia for liver transplantation: Review of the current practice. World J Hepatol. 2015;7(20):2303–2308. doi: 10.4254/wjh.v7.i20.2303][Mufazalova NA, Valeeva LA, Davletshin RA, et al. Nezhelatel’nye lekarstvennye reaktsii. Vzaimodeistvie lekarstvennykh sredstv. Chast’ I. Nesteroidnye protivovospalitel’nye preparaty. Ufa: FGBOU VO BGMU Minzdrava Rossii; 2020. (In Russ).][Chen Q, Chen E, Qian X. A Narrative Review on Perioperative Pain Management Strategies in Enhanced Recovery Pathways-The Past, Present and Future. J Clin Med. 2021;10(12). doi: 10.3390/jcm10122568][Smith LM, Cozowicz C, Uda Y, et al. Neuraxial and Combined Neuraxial/General Anesthesia Compared to General Anesthesia for Major Truncal and Lower Limb Surgery: A Systematic Review and Meta-analysis. Anesth Analg. 2017;125(6):1931–1945. doi: 10.1213/ANE.0000000000002069][Hausken J, Haugaa H, Hagness M, et al. Thoracic Epidural Analgesia for Postoperative Pain Management in Liver Transplantation: A 10-year Study on 685 Liver Transplant Recipients. Transplant Direct. 2021;7(2):e648. doi: 10.1097/TXD.0000000000001101][Repine KM, Hendrickse A, Tran TT, et al. Opioid-Free Epidural-Free Anesthesia for Open Hepatectomy: A Case Report. A A Pract. 2020;14(8):e01238. doi: 10.1213/XAA.0000000000001238][Agarwal V, Divatia JV. Enhanced recovery after surgery in liver resection: current concepts and controversies. Korean J Anesthesiol. 2019;72(2):119–129. doi: 10.4097/kja.d.19.00010][Feltracco P, Brezzi ML, Barbieri S, et al. Epidural anesthesia and analgesia in liver resection and living donor hepatectomy. Transplant Proc. 2008;40(4):1165–1168. doi: 10.1016/j.transproceed.2008.03.108][Shmakov AN, Elizar’eva NL, Kolosov AN, et al. Anesthesiological maintenance of orthotopic liver transplantation in children. Experimental and Clinical Gastroenterology. 2019;(8):61–66. (In Russ). doi: 10.31146/1682-8658-ecg-168-8-61-66.][Kamath PS, Kim WR, Advanced Liver Disease Study G. The model for end-stage liver disease (MELD). Hepatology. 2007;45(3):797–805. doi: 10.1002/hep.21563][Feltracco P, Carollo C, Barbieri S, et al. Pain control after liver transplantation surgery. Transplant Proc. 2014;46(7):2300–2307. doi: 10.1016/j.transproceed.2014.07.023][Ovechkin AM, Bayalieva AZ, Ezhevskaya AA, et al. Postoperative analgesia. Annals of critical care. 2019(4):9–33. doi: 10.21320/1818-474x-2019-4-9-33][Rahimzadeh P, Safari S, Faiz SHR, Alavian SM. Anesthesia for Patients With Liver Disease. Hepatitis Monthly. 2014;14(5):e19881. doi: 10.5812/hepatmon.19881][Matot I, Scheinin O, Eid A, Jurim O. Epidural anesthesia and analgesia in liver resection. Anesth Analg. 2002;95(5):1179–1181, table of contents. doi: 10.1097/00000539-200211000-00009][Narouze S, Benzon HT, Provenzano D, et al. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition): Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain. Reg Anesth Pain Med. 2018;43(3):225–262. doi: 10.1097/AAP.0000000000000700][Nagrebetsky A, Al-Samkari H, Davis NM, et al. Perioperative thrombocytopenia: evidence, evaluation, and emerging therapies. Br J Anaesth. 2019;122(1):19-31. doi: 10.1016/j.bja.2018.09.010][Feltracco P, Brezzi ML, Barbieri S, et al. Epidural anesthesia and analgesia in liver resection and living donor hepatectomy. Transplant Proc. 2008;40(4):1165–1168. doi: 10.1016/j.transproceed.2008.03.108][Cleland S, Corredor C, Ye JJ, et al. Massive haemorrhage in liver transplantation: Consequences, prediction and management. World J Transplant. 2016;6(2):291–305. doi: 10.5500/wjt.v6.i2.291][Likhntsev VV. Infusion Therapy in Peri-Operative Period. Messenger of Anesthesiology and Resuscitation. 2016;13(5):66–73. (In Russ). doi: 10.21292/2078-5658-2016-13-5-66-73][Nikonenko AS, Gritsenko SN, Sobokar’ VA, et al. Anesthesia and intraoperative intensive care for liver transplantation. Meditsina neotlozhnykh sostoyanii. 2013;(6):146–151. (In Russ).][Rando K, Vázquez M, Cerviño G, Zunini G. Hypocalcaemia, hyperkalaemia and massive haemorrhage in liver transplantation. Colombian Journal of Anesthesiology. 2014;42(3):214–219. doi: 10.1016/j.rcae.2014.04.003][Atalan HK, Gucyetmez B, Donmez R, et al. Advantages of Epidural Analgesia on Pulmonary Functions in Liver Transplant Donors. Transplant Proc. 2017;49(6):1351–1356. doi: 10.1016/j.transproceed.2017.03.087][Koul A, Pant D, Rudravaram S, Sood J. Thoracic epidural analgesia in donor hepatectomy: An analysis. Liver Transpl. 2018;24(2):214–221. doi: 10.1002/lt.24989][Clarke H, Chandy T, Srinivas C, et al. Epidural analgesia provides better pain management after live liver donation: a retrospective study. Liver Transpl. 2011;17(3):315–323. doi: 10.1002/lt.22221][Ruscic KJ, Grabitz SD, Rudolph MI, Eikermann M. Prevention of respiratory complications of the surgical patient: actionable plan for continued process improvement. Curr Opin Anaesthesiol. 2017;30(3):399–408. doi: 10.1097/ACO.0000000000000465][Jacquenod P, Wallon G, Gazon M, et al. Incidence and Risk Factors of Coagulation Profile Derangement After Liver Surgery: Implications for the Use of Epidural Analgesia-A Retrospective Cohort Study. Anesth Analg. 2018;126(4):1142–1147. doi: 10.1213/ANE.0000000000002457][Apfel CC, Kranke P, Katz MH, et al. Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design. Br J Anaesth. 2002;88(5):659–668. doi: 10.1093/bja/88.5.659][Marchenkov YV, Ryabchikov MM, Shulgin MA. Comparative Characterization of Various Types of Postoperative Analgesia in Patients with Lung Cancer // General Reanimatology. 2011;7(3):32.(In Russ). doi: 10.15360/1813-9779-2011-3-32][Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth. 2001;87(1):62–72. doi: 10.1093/bja/87.1.62][Baskakov DS, Khoronenko VE. Postoperative Nausea and Vomiting in Cancer Surgery: Present Views on the Solution of the Old Problem. General Reanimatology. 2013;9(2):66. (In Russ). doi: 10.15360/1813-9779-2013-2-66][Trzebicki J, Nicinska B, Blaszczyk B, et al. Thoracic epidural analgesia in anaesthesia for liver transplantation: the 10-year experience of a single centre. Ann Transplant. 2010;15(2):35–39.]