Epidural Anesthesia Associated With Better Pain Control Following Liver Resection

injection, syringe, surgery
Liver resection performed under epidural anesthesia may lead to better postoperative pain control and require the use of fewer systemic opioids.

Patients who undergo liver resection with epidural anesthesia have better postoperative pain control and also require fewer systemic opioids compared with patients who did not receive epidural anesthesia, according to study results published in Pain Medicine.

The study included 110 propensity score matched patients who underwent elective liver resection at a single center in Germany between 2009 and 2016. Patients were divided by whether they did or did not receive epidural anesthesia prior to surgery (n=55 in each group).

Pain greater than or equal to 5 on a numerical rating scale at rest on day 1 following surgery, as well as during movement on postoperative days 1 through 5, comprised the primary outcome measure. Additional outcomes included postoperative complications, length of hospital stay, and 1-year survival. The 1-year survival outcome was compared between the matched cohorts and a frailty model.

Patients who received epidural anesthesia were significantly less likely to report a pain greater than or equal to 5 at rest on postoperative day 1 (25.5% vs 60%; odds ratio [OR], 0.06; 95% CI, 0.01-0.28; P <.001). This finding remained consistent over time (P =.019). In addition, patients who received epidural anesthesia reported significantly lower pain levels during movement (OR, 0.09; 95% CI, 0.03-0.29; P <.001).

No significant difference was found between the 2 groups in terms of the number of postoperative complications (P =.258), the severity of postoperative complications (P >.999), or length of hospital stay (P =.467). A lower 1-year mortality rate was observed in patients who received epidural anesthesia prior to liver resection (9.1% vs 30.9%; hazard ratio, 0.32; 95% CI, 0.11-0.90; P =.031). There were no adverse events associated with epidural anesthesia.

Patients treated with epidural anesthesia had earlier recovery of their bowel function. In addition, patients in the epidural anesthesia group received significantly fewer opioids on postoperative day 1 (P <.001); however, approximately 20% of patients in the epidural anesthesia group did receive additional opioids at day 1, suggesting that a substantial proportion of patients who receive this anesthesia option are unable to achieve pain control.

Limitations of this study included its small sample size as well as the sizable proportion of patients in the epidural anesthesia group that underwent laparoscopic surgery, which is typically associated with fewer postoperative complications and shorter length of hospital stay.

The researchers concluded that further research may be helpful in “the development of a guideline for the use of epidural anesthesia in liver surgery,” and that this guideline “would provide valuable assistance to anesthesiologists by allowing preoperative risk stratification of patients.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Knaak C, Spies C, Schneider A, et al. Epidural anesthesia in liver surgery-a propensity score-matched analysis [Published online July 11, 2020]. Pain Med. doi:10.1093/pm/pnaa130