Background and aims The purpose of this study is to analyze whether supplementation of general anesthesia with thoracic epidural analgesia is a safe modality of pain relief and prevention of bleeding during liver resection.

Methods We collected data from a prospectively maintained database of 68 patients who underwent open liver surgery by a bilateral subcostal incision. Patients were randomly allocated equally into Group A (n=31) (GA, epidural anaesthesia) and Group B (n=37) (GA) by sealed envelope technique. Anaesthetic consultants with expertise in anaesthesia for liver surgery performed the epidural catheter placement. Thoracic epidural catheters were placed between T7-T8 interspaces preoperatively. The heart rate, systolic blood pressure, diastolic blood pressure, mean blood pressure variations and CVP were compared between Groups A and B at different time intervals intraoperatively. Changes to the epidural or intravenous morphine were evaluated as required by the Acute Pain Service. The outcome was measured in terms of epidural success rates, pain scores, and length of hospital stay.

Results The hemodynamic response at the time of liver resection was higher in Group B as compared to Group A (CVP: Group A 2,1±0.1 vs Group B 4,2±0.4, p<0.05). Postoperative pain scores were better in epidural group as compared to IV analgesia group up to 48 h.

Conclusions General/epidural anaesthesia decreases both venous return and portal vein pressure, thus contributing to reduced hepatic congestion and surgical blood loss. In addition, placement of a thoracic epidural catheter delivering a local anesthetic with opiates provided safe and effective pain control in patients undergoing major liver resection.