Purpose: To compare the post operative pain control of four distinct management strategies in adult live donor hepatectomy.

Methods: Sixty-two ASA physical status I and II patients undergoing live donor hepatic resection from 2001 to 2008 were retrospectively organized into four groups for post-operative pain control. Group A received epidural catheter, Group B received PCA, Group C received intraoperative dexmedetomidine and PCA, and Group D received perioperative gabapentin, intraoperative dexmedetomidine, and PCA. Four day postoperative visual analog pain scores (VAS), intravenous morphine equivalent use, duration of hospitalization, and time until return of bowel function was measured.

Results: Mean visual analog pain score for a cumulative four day postoperative interval demonstrated 2.2 (± 0.73) for epidural catheter, 3.4 (± 1.13) for patient controlled analgesia (PCA), 3.0 (± 1.42) for intraoperative dexmedetomidine infusion plus PCA, and 2.3 (± 1.09) for perioperative gabapentin, intraoperative dexmedetomidine, combined with PCA. These results achieved statistical significance with p = 0.0443. Total intravenous morphine equivalent use was similar between the three non-epidural groups. There was no difference in length of hospitalization or time until return of bowel function amongst the four groups.

Conclusions: Both epidural infusion and a three drug regimen of perioperative gabapentin, intraoperative dexmedetomidine, and PCA produced superior postoperative pain control compared with PCA alone or a combination of PCA and dexmedetomidine. The three drug regimen represents a preferred strategy as it provides optimal pain control without the theoretic risk of epidural hematoma in patients with a predictable postoperative coagulopathy. This pilot study serves as a template for future prospective examination of this three drug regimen versus epidural in major non-hepatic open abdominal surgery where post operative coagulopathy is less of a concern.

Objective: To introduce a method for harvesting pure hepatic vein (HV) blood and to determine time course and peak level of posthepatic (HV blood) reactive oxygen species (ROS) after liver transplantation. Materials and methods: Blood was taken from HV and infrahepatic vena cava (IH-VC) for malondialdehyde (MDA) detection at different time points after transplantation.

Results: Pure posthepatic blood from HV was successfully obtained using the technique of IH-VC cannulation. This method guaranteed the harvesting of pure posthepatic blood from HV and pure peripheral blood from IH-VC. MDA concentration in HV elevated obviously with time and peaked at 1h after transplantation. MDA concentration at 1h was significantly higher than that at other time points except for 5 min. Furthermore, MDA concentrations in HV were significantly higher than that in IH-VC at 20 min, 30 min, 1h ( P <0.05) and slightly higher at all other time points. MDA concentration within IH-VC peaked at 2h after transplantation.

Conclusion: We introduced a novel technique for harvesting pure posthepatic blood from HV using the manipulation of IH-VC cannulation. We provided the first evidence that posthepatic ROS concentration elevated with time and peaked at 1h after transplantation.