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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
NONE
Enrollment
106
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.
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.
Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
Hangzhou, Zhejiang, China
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)
Time frame: 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)
Time frame: 2h, 6h, 12h, 24h, 48h postoperatively
Intraoperative Opioid Consumption
Total remifentanil dose administered: Measured in micrograms (μg) Recorded from anesthesia machine
Time frame: Anesthesia induction to extubation
Hospital Length of Stay
Duration from surgery end to discharge: Measured in days From electronic medical records
Time frame: Up to 30 days post-surgery
Adverse Event Incidence
Percentage of patients with: Nausea/vomiting Delirium (CAM-positive) Other complications
Time frame: 0-72 hours postoperatively
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