This study aims to compare the efficacy and safety of three alternative methods of analgesia
in patients undergoing complex liver resection surgery: 1) thoracic epidural analgesia (TEA),
2) continuous paravertebral block (PVB) with patient-controlled analgesia (PCA) and 3)
patient-controlled analgesia (PCA) alone. Regional anesthesia techniques such as TEA and PVB
may improve recovery and decrease postoperative pain scores in addition to other benefits
such earlier return of bowel function and shortened length of hospital stay, although some
practitioners have voiced concerns about the safety and efficacy of these techniques in
patients after liver resection who may develop postoperative coagulation abnormalities. The
investigators plan to enroll a total of 150 patients (adults >/= 18 years of age who meet
study criteria) scheduled for complex liver resection surgery in this study, who will then be
randomized into 50 patients per arm of the study (3 total arms). Postoperative pain scores
will be collected in PACU and throughout the patient's hospital stay as well as routine blood
tests including complete blood count, coagulation labs (PT/INR, aPTT) and serum creatinine to
measure renal function. The study team will also collect additional data prospectively on all
patients enrolled in the study; these parameters will include age, sex, type of operation
performed, length of operation, volume of intraoperative blood loss, volume of intraoperative
fluid administration including blood products, daily postoperative intravenous fluid
administration, length of time to first feeding, day of epidural catheter removal, length of
hospital stay and incidence of major postoperative complications (surgical, respiratory,
cardiac, renal, etc.). Once primary and secondary data points are obtained, the data will
undergo rigorous statistical analysis using the appropriate statistical techniques to
determine the outcomes. The investigators propose that epidural and/or paravertebral
analgesia may improve recovery times and decrease hospital length of stay, which would be
beneficial for the patient as well as decrease hospital costs. In addition, if better
postoperative pain management scores can be achieved with epidural or paravertebral
analgesia, and no significant prolonged postoperative coagulopathy is associated with
patients undergoing major hepatic resection surgical procedures, these regional analgesia
strategies can be considered a safe option for pain management in this patient population.