Effects of Different Anesthetic Techniques on Intraoperative and Postoperative Pain Levels and Cognitive Function in Patients Undergoing Hepatectomy for Liver Cancer

Sir Run Run Shaw Hospital, Qingchun Campus, Zhejiang University School of Medicine,

Status: Completed

Conditions: Postoperative Pain; Hepatectomy; Epidural-general Anesthesia; Cognitive Dysfunction; Liver Cancer; Anesthesia Techniques

Treatments: Drug: General-Epidural Anesthesia (GEA) group; Drug: General Anesthesia (GA) group

Study type: Interventional

Funder types: Other

Identifiers

NCT07097220

No. 2025-0355

Details and patient eligibility

About

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.

Full description

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.

Enrollment: 106 patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

• Inclusion Criteria:
• Histologically or radiologically confirmed primary liver cancer (HCC or cholangiocarcinoma)
• Scheduled for elective open or laparoscopic radical hepatectomy
• Age 18-75 years
• ASA Physical Status I-III
• Child-Pugh class A or B liver function
• Normal preoperative MoCA score (≥26)
• Willing to participate and provide informed consent
• Exclusion Criteria:
• Severe cardiovascular, pulmonary or renal disease (ASA IV/V)
• Chronic pain disorders or preoperative opioid use (>3 months)
• Known neurologic/psychiatric conditions (dementia, stroke, epilepsy)
• Concurrent major procedures (e.g., vascular resection)
• Intraoperative conversion to palliative surgery
• Massive intraoperative hemorrhage (>2000 mL)
• Coagulopathy (INR >1.5 or platelets <50×10⁹/L)
• Spinal abnormalities precluding epidural catheterization
• Pregnancy or lactation
• Allergy to local anesthetics or study medications

Trial design

Primary purpose: Basic Science

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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106 participants in 2 patient groups

general anesthesia group

Experimental group

Description:

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.

Treatment:

Drug: General Anesthesia (GA) group

General-Epidural Anesthesia group

Experimental group

Description:

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.

Treatment:

Drug: General-Epidural Anesthesia (GEA) group