
Background and Goal of Study:
Epidural analgesia (EA) is the most widely used analgesic technique for open abdominal surgery. However,  in patients undergoing extensive liver resections, performing an epidural puncture with the insertion of an  epidural catheter has potential morbidity due to the perioperative altered coagulation profiles these patients  can experience. New analgesic modalities have emerged recently, such as the modified BRILMA block,  scarcely investigated in this context.

The aim of this study was to assess the effectiveness of EA with epidural infusion of local anesthetics  compared to the modified BRILMA block associated with a PCA of morphine (MPCA) as postoperative  analgesia in open liver resections.
Materials and Methods:
We compared a retrospective series of patients who underwent open liver resection surgery and  received EA with epidural infusion of local anesthetics during 2015 2016, with a cohort of patients who  received a modified BRILMA block in addition to a MPCA during 2016. The intensity of pain at rest and  movement was registered according to the visual analogue scale (VAS), in the immediate postoperative  period, at 6 hrs, 24 hrs and 48 hrs after surgery.
Results and Discussion:
A total of 20 patients undergoing open liver resection were included. Fourteen patients in the EA group and  six patients in the BRILMA group were compared. There were no differences between the two groups in  terms of age (61±9 vs 62±10 years), sex (women/males 6/8 vs 2/5) and surgical risk estimation scale (ASA 
II/III, 11/3 vs 6/0) but it was in body mass index (BMI 26±3 vs 29±3 kg/m2;p<0.05) in EA and BRILMA  group, respectively.We found better analgesic control immediately after surgery (0 vs 1) and at 6hs (0 vs 2) of postoperative 
period in EA than in BRILMA group. However, VAS scores were similar at 24 hrs (2 vs 2) and 48hs (2 vs 2)  at rest, and at 24h (4 vs 3) and 48hs (3 vs 3) in motion in EA and BRILMA groups, respectively.
Conclusions:
The modified BRILMA block associated with a MPCA is not as effective as EA in the immediate and at 6 hrs  of postoperative period but it provides a good analgesic control without significant differences in pain scores  at 24 hrs and 48 hrs after surgery. A BRILMA block associated with a MPCA is a promising alternative to 
EA for the control of postoperative pain in patients undergoing open liver surgery. Studies with larger  number of patients are needed to confirm these results.

04 / Postoperative analgesic quality of the BRILMA block vs continous epidural infusion in open liver surgery.