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To evaluate the effects of general anesthesia (GA) versus combined general and epidural anesthesia (GEA) on postoperative pain, cognitive dysfunction (POCD), hospital stay, and recovery quality in liver cancer patients undergoing hepatectomy.
A retrospective analysis of 80 liver cancer patients was conducted, categorized by analgesic adequacy, pain recovery, and POCD incidence: adequate vs. inadequate analgesia (n=50 vs. n=30), favorable vs. delayed pain recovery (n=36 vs. n=44), and POCD vs. non-POCD (n=42 vs. n=38). Based on these results, a prospective study (April 2024-April 2025) enrolled patients scheduled for elective hepatectomy, assigned to the GA group (n=59) or GEA group (n=47). Primary outcomes included intraoperative analgesic consumption, postoperative VAS pain scores, MoCA cognitive scores, hospital stay length, and adverse event rates.
Compared to GA alone, combined epidural-general anesthesia provides better perioperative pain control, reduces POCD risk, shortens hospitalization, and enhances recovery. GEA is a preferable anesthetic approach for liver cancer surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| general anesthesia group | Experimental | In the General Anesthesia (GA) group (n = 59), patients received combined intravenous-inhalation general anesthesia. Anesthesia induction was performed using propofol and remifentanil, followed by maintenance with sevoflurane to ensure adequate anesthetic depth and hemodynamic stability throughout the procedure. |
|
| General-Epidural Anesthesia group | Experimental | In the General-Epidural Anesthesia (GEA) group (n = 47), patients received the same general anesthesia protocol as the GA group, in addition to epidural anesthesia. An epidural catheter was placed preoperatively at the T7-T9 vertebral level using a midline approach under strict aseptic conditions. Following successful catheterization and confirmation of proper placement, a continuous intraoperative infusion of 0.25% ropivacaine was administered via the epidural route to provide segmental analgesia and reduce intraoperative opioid requirements. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| General Anesthesia (GA) group | Drug | In the General Anesthesia (GA) group (n = 59), patients received combined intravenous-inhalation general anesthesia. Anesthesia induction was performed using propofol and remifentanil, followed by maintenance with sevoflurane to ensure adequate anesthetic depth and hemodynamic stability throughout the procedure. |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative Cognitive Dysfunction (POCD) | Percentage of patients with: MoCA score <26 at postoperative assessment OR ≥2-point decrease from preoperative baseline (Assessed using Montreal Cognitive Assessment, 30-point scale) | Baseline (preoperative), POD1 (24±4h), POD3 (72±6h) |
| Postoperative Pain Intensity | Mean pain scores measured by: Visual Analog Scale (VAS) 10cm scale (0=no pain, 10=worst pain) | 2h, 6h, 12h, 24h, 48h postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| Intraoperative Opioid Consumption | Total remifentanil dose administered: Measured in micrograms (μg) Recorded from anesthesia machine | Anesthesia induction to extubation |
| Hospital Length of Stay |
| Measure | Description | Time Frame |
|---|---|---|
| Intraoperative Analgesic Adequacy | Percentage of patients with: Grade I (adequate) vs Grades II-IV (inadequate) analgesia (Per Supplementary Table S1 criteria) | Entire surgical duration |
| Surgical Stress Correlation |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Sir Run Run Shaw Hospital, Zhejiang University School of Medicine | Hangzhou | Zhejiang | 310015 | China |
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|
| General-Epidural Anesthesia (GEA) group | Drug | In the General-Epidural Anesthesia (GEA) group (n = 47), patients received the same general anesthesia protocol as the GA group, in addition to epidural anesthesia. An epidural catheter was placed preoperatively at the T7-T9 vertebral level using a midline approach under strict aseptic conditions. Following successful catheterization and confirmation of proper placement, a continuous intraoperative infusion of 0.25% ropivacaine was administered via the epidural route to provide segmental analgesia and reduce intraoperative opioid requirements. |
|
Duration from surgery end to discharge:
Measured in days
From electronic medical records
| Up to 30 days post-surgery |
| Adverse Event Incidence | Percentage of patients with: Nausea/vomiting Delirium (CAM-positive) Other complications | 0-72 hours postoperatively |
Pearson correlation coefficients between:
Anesthesia technique (GA/GEA)
Blood loss (mL)
Surgery duration (min)
| Intraoperative period |
| ID | Term |
|---|---|
| D008113 | Liver Neoplasms |
| D010149 | Pain, Postoperative |
| D060825 | Cognitive Dysfunction |
| ID | Term |
|---|---|
| D004067 | Digestive System Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D004066 | Digestive System Diseases |
| D008107 | Liver Diseases |
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D003072 | Cognition Disorders |
| D019965 | Neurocognitive Disorders |
| D001523 | Mental Disorders |
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| ID | Term |
|---|---|
| D000768 | Anesthesia, General |
| D044382 | Population Groups |
| ID | Term |
|---|---|
| D000758 | Anesthesia |
| D000760 | Anesthesia and Analgesia |
| D003710 | Demography |
| D011154 | Population Characteristics |
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