Ropivacaine combined with sufentanil analgesia accelerates postoperative recovery after hepatectomy in patients with cirrhotic portal hypertension

Abstract

Objective To investigate the application value of ropivacaine combined with sufentanil in the analgesia after hepatectomy in patients with cirrhotic portal hypertension. Methods Clinical data of 22 patients with cirrhotic portal hypertension who underwent hepatectomy in the Third Affiliated Hospital of Sun Yat-sen University between September 2015 and June 2016 were retrospectively analyzed. Among them, 14 cases were males and 8 females, aged 38-75 years old with a median age of 51 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the postoperative analgesia method, all patients were divided into the ropivacaine combined with sufentanil group (combination group, n=9) and sufentanil group (control group, n=13). Regional incisional administration of ropivacaine combined with sufentanil via patient controlled intravenous analgesia (PCIA) were used for postoperative analgesia in the combination group, while sufentanil alone via PCIA was used in the control group. The degree of postoperative pain, liver function, healing of surgical incision and incidence of postoperative complications were observed in two groups. The visual analogue scale (VAS) and liver function Child-Pugh score in two groups were compared using t test. Results The VAS at postoperative 4, 8, 12, 24 and 48 h in the combination group was respectively 2.8±1.2, 3.1±1.1, 2.8±0.7, 2.4±1.0 and 2.4±0.9, significantly lower than 5.2±1.6, 5.1±1.4, 4.9±1.4, 4.5±1.0 and 3.5±1.1 in the control group (t=-3.82, -3.49, -4.30, -4.90, -2.56; P<0.05). The surgical incisions healed well in both groups and were graded as Ⅱ/A. No lower extremity deep venous thrombosis or pulmonary embolism were observed in the combination group, while postoperative lower extremity deep venous thrombosis and mild pulmonary embolism were observed in 1 case of the control group, and the patient got better after conservative therapy. Conclusions Regional incisional administration of ropivacaine combined with sufentanil via PCIA can effectively improve the pain after hepatectomy and accelerate postoperative recovery, which is a safe and efficacious combined-analgesia approach for patients with cirrhotic portal hypertension. Key words: Anesthetics, local; Anesthetics, general; Analgesia; Liver cirrosis; Hypertension, portal; Hepatectomy; Enhanced recovery after surgery