Epidural Anesthesia in Liver Surgery-A Propensity Score-Matched Analysis

Objective. To assess the effects of epidural anesthesia (EA) on patients who underwent liver resection. Design. Secondary analysis of a prospective randomized controlled trial. Setting. This single-center study was conducted at an academic medical center. Methods. A subset of 110 1:1 propensity score-matched patients who underwent liver resection with and without EA were analyzed. Outcome measures were pain intensity >= 5 on a numeric rating scale (NRS) at rest and during movement on postoperative days 1-5, analyzed with logistic mixed-effects models, and postoperative complications according to the Clavien-Dindo classification, length of hospital stay (LOS), and one-year survival. One-year survival in the matched cohorts was compared using a frailty model. Results. EA patients were less likely to experience NRS >= 5 at rest (odds ratio = 0.06, 95% confidence interval [CI] = 0.01 to 0.28, P<0.001). These findings were independent of age, sex, Charlson comorbidity index, baseline NRS, and surgical approach (open vs laparoscopic). The number and severity of postoperative complications and LOS were comparable between groups (P = 0.258, P>0.999, and P = 0.467, respectively). Reduced mortality rates were seen in the EA group one year after surgery (9.1% vs 30.9%, hazard ratio = 0.32, 95% CI = 0.11 to 0.90, P = 0.031). No EA-related adverse events occurred. Earlier recovery of bowel function was seen in EA patients. Conclusions. Patients with EA had better postoperative pain control and required fewer systemic opioids. Postoperative complications and LOS did not differ, although one-year survival was significantly improved in patients with EA. EA applied in liver surgery was effective and safe.