Thoracic epidural analgesia in donor hepatectomy: An analysis

We read with great interest the article of Koul et al. in a recent issue of Liver Transplantation. The authors performed a retrospective analysis of 104 patients who received thoracic epidural anesthesia (TEA) for right lobe donor hepatectomy and concluded that vigilant use of TEA appears to be safe during donor hepatectomy. The authors should be congratulated for performing a welldesigned study in an important topic (eg, acute pain strategy) in patients undergoing hepatectomy surgery. The current emphasis on the need to use regional anesthesia to improve postoperative outcomes makes the topic very relevant in perioperative medicine. Although the study of Koul et al. was well conducted, there are some questions regarding the study that need to be clarified by the authors. First, the small sample size does not allow the authors to exclude potential complications. The upper limit of the confidence interval for complications can still be on the vicinity of 10% even if no complications were observed. Second, it is unclear if the intraoperative analgesic regimen was standardized for all patients because this can influence some of the outcomes (eg, pain). Lastly, other analgesic strategies (eg, transversus abdominis plane block, long-acting local anesthetic formulations) have been shown to be effective to improve postoperative analgesia, and they do not have the same risk profile as thoracic epidurals. We would welcome some comments by the authors because this would help to further validate the findings of this important clinical trial.