Paravertebral vs. Epidural Analgesia for Liver Surgery (PEALS): protocol for a randomized controlled pilot study

Perioperative thoracic epidural analgesia (TEA) is commonly used in hepatectomy patients since it is opioid-sparing and reduces cardiorespiratory complications. However, TEA has a high failure rate and is associated with potentially devastating complications (particularly spinal hematoma) and the risk is increased with hepatectomy. Thus, some centres favour systemic opioid-based modalities which, in turn, are associated with inferior analgesia and well-known risks/side-effects. Hence, alternative analgesic methods are desirable. Paravertebral block (PVB) has been used in liver resection with advantages including hemodynamic stability, low failure rates, and low risk of spinal hematoma. Our purpose is to conduct a blinded, pilot RCT with hepatectomy patients randomized to receive TEA or PVB for perioperative analgesia.