Perioperative analgesic approaches in hepatobiliary cancer malignancies: Experience from a tertiary care centre.
Surabhi Sandill, Seema Mishra156
Background: Peri-operative analgesic management in hepatobiliary cancer surgeries is crucial for enhancing patient recovery and outcomes. This study presents insights from a tertiary care centre practice, highlighting the effective analgesic strategies tailored to the complex needs of patients with hepatobiliary malignancies. Methods: Retrospective observational study of hepatobiliary cancer patients operated between 1st June, 2020 and 31st May, 2025. Data collected using medical records and hospital database. The aim of our study was to assess perioperative analgesic strategies employed in hepatobiliary malignancy surgeries. Results: A total of 412 patients were operated for hepatobiliary malignancies between 1st June, 2020 and 31st May, 2025. The mean age was 52 years with 51.2% male patients. Most of the patients belonged to ASA-II (50.48%) and ASA-III (33.98%). The most common surgery performed was radical cholecystectomy (31.7%), whippers procedure (29.8%), palliative procedures (14.6%). Commonly employed intra-operative anaesthesia plan was general with neuraxial anaesthesia (69.17%) - epidural anaesthesia (54.77%). Lower NRS scores (both on rest and movement) on post operative day 1, 2 were observed in patients who received neuraxial block (p<0.05) in comparison to those who receive only GA or GA with regional block. Common complications seen with neuraxial analgesia were vomiting, urinary retention, pruritis (p>0.05). The postoperative outcomes including hospital stay, surgical complications and 30-day mortality showed no statistical difference between different perioperative analgesic modalities (p>0.1). Conclusions: In our experience at a tertiary care centre, epidural analgesia emerged as a highly effective perioperative analgesic approach in patients undergoing surgery for hepatobiliary malignancies. It provided superior pain control post-operatively and contributed to early recovery and improved postoperative outcomes.