Thoracic epidural analgesia (TEA) can provide effective postoperative analgesia after major abdominal and/or thoracic surgery. The use of epidural analgesia, however, remains low and may prolong hospital stay after certain open surgical procedures. Current Enhanced Recovery After Surgery (ERAS) guidelines do not recommend TEA in open liver surgery. In this randomized controlled trial, 143 patients undergoing open liver resection (February 2012-February 2016) were randomized to receive either intravenous patient-controlled analgesia (IV-PCA) and non-steroidal analgesia, or TEA within an ERAS protocol, to determine whether the former could be as effective as TEA in patients undergoing open liver surgery. Single dose dexamethasone and acetaminophen were given to both groups. Researchers found that the mean numeric rating scale (NRS) pain score was 1.7 in the IV-PCA group and 1.6 in the TEA group, demonstrating noninferiority. Interestingly, while pain scores were lower in the TEA group on post-operative days 0 and 1, they were higher or equal on post-operative days 2 and 5. In keeping with previous research, the median post-operative hospital stay was shorter for individuals in the IV-PCA group at 74 hours, as compared to 104 hours in the TEA group (p<0.001). This study therefore shows that IV-PCA may be non-inferior TEA in the management of postoperative pain in patients undergoing open liver surgery.
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