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Postoperative analgesia in laparoscopic liver resection: An international survey
Manu-Priya Sharma1, Georgina Cubas1, Simon Cottam2, James Gill1, Gudrun Kunst3, Zoka Milan4
1Locum Consultant Anesthetist, King's College Hospital, London, UK.
2Clinical director of Anesthesia, King's College Hospital, London, UK.
3Consultant Anesthetist, Research Clinical Lead, Reader in cardiac anesthesia, King's College Hospital, London, UK.
4Consultant Anesthetist, Honorary Senior Lecturer, Visiting Professor, King's College Hospital, London, UK.

Article ID: 100008A05MS2016
doi:10.5348/A05-2016-8-OA-4

Address correspondence to:
Zoka Milan
Anaesthetic Department, King's College Hospital
Denmark Hill
London SE5 9RS
UK

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How to cite this article
Manu-Priya S, Cubas G, Cottam S, Gill J, Kunst G, Milan Z. Postoperative analgesia in laparoscopic liver resection: An international survey. Edorium J Anesth 2016;2:14–19.


Abstract
Aims: We undertook a worldwide survey of current practices regarding postoperative analgesic management of laparoscopic hepatic resection (LHR).
Methods: An online 10-question survey was sent to hepatobiliary units worldwide.
Results: Forty-five responses were received. Anticipated postoperative pain was described as "less intense" in LHR when compared to open hepatic resection (OHR) in 41/45 centers and "equally intense" in 3/45, and "more intense" in 1/45. Only 2/45 respondents thought that the pain score was lower than 2. Most of the responses (11/45) indicated VAS 4, while all the scores above 4 were represented equally. Overall, 2/5 of the centres used the same method of analgesia for LLR as for OLR, while 3/5 of the centres used different methods of analgesia. Centres that used the same type of analgesia used mainly epidural (7/18) and PCA or opioid infusion (6/18). Centres that had changed the type of analgesia for LLR used mainly PCA or opioid infusion (18/27). Generally, PCA or opioid infusion was the most common type of analgesia, followed by epidural and intrathecal anesthesia. Regarding length of hospital stay (LOS), 30% reported LOS of <3 days, 44% between 4–6 days, 15% 7–9 days and 4% 10 days.
Conclusion: Our survey shows evidence of varied perception of the intensity of postoperative pain following LHR and, consequently, variety in postoperative analgesia technique, which, contribute to different LOS. It has also shown the need for: 1) audits and 2) RCTs and improvement in communication and information exchange between centers about postoperative analgesia in LHR.

Keywords: Analgesia, Laparoscopic, Liver resection, Postoperative


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Author Contributions:
Manu-Priya Sharma – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Georgina Cubas – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Simon Cottam – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
James Gill – Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Gudrun Kunst – Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Zoka Milan – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Manu-Priya Sharma et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.