Duration of the thoracic epidural catheter in a fast-track recovery protocol may decrease the length of stay after a major hepatectomy: A case control study

BackgroundFast-track recovery protocols are applied to major surgeries, including hepatectomies. The optimal duration of thoracic epidural catheter has not yet been defined.ObjectiveTo determine the ideal time to remove the epidural catheter after major hepatectomy.Patients–methodsForty-eight consecutive patients who underwent major hepatectomy over 4 years were studied. The data from laparoscopic hepatectomy were not included. Patients who underwent hepaticojejunostomy were included. A modified protocol of rapid postoperative recovery was implemented. In the first 24 patients, an epidural catheter was maintained for 4 days (group A), while in the next 24, the catheter was maintained for 2 days (group B). The length of hospital stay, time of functional recovery, and use of opioids and laxatives were recorded.ResultsThere was no postoperative mortality. The average length of hospital stay was 6.92 ± 1.79 and 6.09 ± 2.08 days for groups A and B, respectively. The mean functional recovery was 5.46 ± 0.3 and 5.26 ± 0.91 days for groups A and B, respectively. However, in group B, more opioid analgesics by 50% and more laxatives by 17% were used.ConclusionsAfter major hepatectomy, a reduction from 4 to 2 days' duration of the epidural catheter may lead to a reduction in the length of hospital stay.