Thoracic epidural analgesia in anaesthesia for liver transplantation: the 10-year experience of a single centre.

BACKGROUND: Improvements in operating techniques, methods of anaesthesia and postoperative care in liver transplantation (LT) contribute to better outcomes. In order to restrict postoperative mechanical ventilation, a thoracic epidural analgesia (TEA) has been performed in our centre since 2000. In this report we present our 10-year experience of using TEA as a component of LT anaesthesia. MATERIAL/METHODS: TEA was performed, by anaesthetists experienced in this method, on patients qualified for LT, who consented and met inclusion criteria: INR<1.5, APTT<45s and platelets >70 G/L. Since 2008 the decision to insert an epidural catheter has been additionally supported by thromboelastometry. We assessed extubation time, frequency of complications of TEA and undesired accidents. RESULTS: From 279 patients undergoing LT, TEA was performed on 67 (24%), and from these 56 (84%) were extubated in the operating theatre. There were 5 cases of unsatisfactory thoracic epidural analgesia. Only 1 epidural catheter was removed accidentally, on the 2nd postoperative day. None of the complications of TEA were observed in the TEA group. CONCLUSIONS: Based on our observations, it can be assumed that TEA done by experienced an anaesthetist is a safe component of anaesthesia in selected groups of patients undergoing LT, and allows for early extubation.