Effects of the Supine and Reverse Trendelenburg Positions on Central Venous Pressure During Hepatectomy: A Prospective Randomized Controlled Trial
Paramin Muangkaew¹, Ratima Vangsawang¹, Somkit Mingphruedhi¹, Narongsak Rungsakulkij¹, Pongsatorn Tangtawee¹, Wikran Suragul¹, Watoo Vassanasiri¹, Suraida Aeesoa¹, Worapot Apinyachon²
Affiliation : ¹ Division of Hepato-Pancreato-Biliary Division, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; ² Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background: Hepatectomy is an operation that has potentially significant blood loss. The low central venous pressure (CVP) technique has been accepted as a method to minimize blood loss during hepatectomy. From previous studies, reverse Trendelenburg position (rTP) decreased CVP, however, no randomized control study has compared the effectiveness of these techniques in terms of reducing CVP and decreasing blood loss.
Objective: To demonstrate the benefit of rTP in lowering the CVP and blood loss compared to the supine position (SP) during hepatectomy.
Materials and Methods: The present randomized, controlled two-arm trial was conducted between March 2021 and October 2023. The patients who underwent open hepatectomy were randomized into two groups, the SP and the rTP groups. The primary outcome was CVP during liver resection and secondary outcome was blood loss and rate of blood transfusion.
Results: One hundred and twelve patients undergoing open hepatectomy were randomized into two groups. Fifty-seven patients were allocated to the SP group while rTP group was applied to 55 patients. The baseline CVP in the SP group was 6.9±3.0 centimeters of water column (cmH₂O), and in the rTP group was 6.5±2.9 cmH₂O. The average CVP from 0 to 60 minutes was significantly decreased from 7.0±2.7 in SP group to 5.3±2.7 in rTP group (p=0.001). The spot CVP was significantly lower at 5, 15, 45, and 60 minutes after adjusting position. There was no significant difference in total blood loss and rate of blood transfusion during liver resection between the two groups. However, in the rTP group, blood loss during the transection of the liver may be reduced and the transection time may be less.
Conclusion: The present study demonstrated that the rTP is effective in lowering CVP. It can reduce CVP after position adjustment for 60 minutes, but it could not reduce blood loss.
Trial registration: Thai Clinical Trials Registry, TCTR20210614001
Received 3 July 2025 | Revised 29 September 2025 | Accepted 9 October 2025
DOI: 10.35755/jmedassocthai.2025.11.928-935-03221
Keywords : Low central venous pressure; Position; Hepatectomy, Reverse Trendelenburg; Blood loss; Blood transfusion
