The Safety of Epidural Analgesia for Open Hepatectomy- will Epidural Hematoma Occur? A Retrospective Study
Vimolluck Sanansilp MD*, Virachat Sanansilp MD*, Sajjaporn Innipat MD*
Affiliation : * Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To study the safety of the epidural analgesia technique among patients undergoing open hepatectomy.
Material and Method: A retrospective review of all medical records of patients who had undergone open liver surgery was
done, using ICD-9-CM procedure code numbers to search from January 2010 to December 2015. The patient demographic
data, preoperative and postoperative liver enzymes and coagulation function, size and weight of portion of the liver were
collected and analyzed.
Results : From 2010 to 2015, 1,047 medical records were consecutively recruited. After following the exclusion criteria, 632
patients undergoing major hepatectomy for liver diseases per se and who were administered continuous epidural analgesia
were eligible for analysis. According to the records, no epidural hematoma occurred [0/632 = 0%, 95% confidence interval
0 to 0.6%], even when the postoperative liver functions were abnormal. High prothrombin time (PT), high activated partial
thromboplast in time (aPTT), low albumin level, high aspartate aminotransferase level, high alanine aminotransferase level,
and thrombocytopenia were found in 90.5%, 46.2%, 86.8%, 86.3%, 92.4%, and 28.3% of laboratory-requested cases,
respectively. A fair degree of relationship between either the portion of the liver size or weight and the PT abnormality was
found, but there was little or no relationship with a PTT abnormality.
Conclusion : Major hepatectomy can cause abnormal liver function, especially coagulopathy, which may be associated with
epidural hematoma after epidural catheter manipulation. However, the present study showed that epidural hematoma did not
occur among those patients with epidural analgesia who developed coagulopathy after liver resection. The authors concluded
that epidural analgesia may be safe for patients undergoing major hepatectomy who had normal, or even slightly abnormal,
preoperative coagulogram.
Keywords : Epidural analgesia, Epidural hematoma, Hepatectomy, Coagulopathy
