• Anthony M H Ho, Anna Lee, Manoj K Karmakar, Winnie Samy, Paul B S Lai, Olivia A Ho, and Amy Cho.
• Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong Prince of Wales Hospital, Shatin, NT, Hong Kong. hoamh@cuhk.edu.hk
• Hepato Gastroenterol. 2007 Jul 1;54(77):1494-8.

Background/AimsEpidural analgesia improves postoperative outcome, and should benefit patients undergoing hepatectomy for cancer. However, the combination of underlying disease, surgery, and blood loss after hepatectomy may lead to hemostatic changes that, theoretically, increase the risk of epidural hematoma. To quantify these changes, we retrospectively reviewed the records of 229 patients at the Prince of Wales Hospital, Hong Kong.MethodologyWe analyzed the hemostatic parameters of those in whom there were complete data (n=143) up to postoperative day 3.ResultsWe found considerable derangements in the international normalized ratio (INR), prothrombin time, activated partial thromboplastin time (aPTT), and platelet counts, with peak derangements occurring around postoperative day 2. The amount of liver resected and the preoperative Model for End-Stage Liver Disease score were predictors of peak INR > or = 1.5 in the postoperative period.ConclusionsWe conclude that commonly measured hemostatic parameters are deranged after hepatectomy for cancer. Because of the complex cancer- and surgery-related hemostatic changes, whether these changes indeed indicate increased risk of neuraxial hematoma associated with neuraxial blocks is unclear. We also found that most Chinese patients were managed adequately with patient-controlled intravenous morphine. Clinicians contemplating neuraxial block on patients undergoing hepatectomy for cancer must weigh the potential risks and benefits.

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