engleski

Dynamics of change in coagulation parameters in carcinoma patients with epidural analgesia following liver resection

Background and Purpose: Liver resection is associated with postoperative coagulopathy. There is a risk of occurrence fatal epidural anaesthesia (EA) complications. The purpose of this study is to monitor the dynamics of change in coagulation parameters with regard to the resected mass of the liver tissue in patients with continuous thoracic epidural analgesia. Materials and Methods: The retrospective study included 57 patients, with liver resection performed due to metastases of colon carcinoma with normal preoperative coagulation status, that underwent the technique of continuous thoracic epidural analgesia (TEA) and general anaesthesia. The patients were divided into two groups depending on the number of resected liver segments. The Small Resections’ group (SR) included patients that had one or two liver segments removed while the Major Resection (MR) group included patients that had three of more liver segments removed.Resected liver tissue mass, prothrombin time (PT) values and platelet count were analyzed during five postoperative days (PODs). Results and Conclusions: There is a statistically significant difference of PT value (p<0.001) during five days within each of the tested groups, as well as between both groups (p<0.001). During all five PODs there is a negative correlation between PT values and removed liver tissue mass in both patient groups. The analysis showed that by removing liver mass larger than 165 gwe can expect PT<0.7. TEA application after liver resection is a technique that demands individual assessment of the expected patient postoperative coagulation status. Resected liver tissue mass can be an effective predictor of postoperative coagulopathy.

Epidural analgesia; Postoperative pain; Coagulation; Liver resection

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