A comparison of regional anesthesia techniques for pain management in patients undergoing liver surgery: a network...

This research aimed to evaluate the pain-relieving effectiveness and practicality of various regional anesthesia approaches in individuals undergoing hepatic procedures.

A total of 10 randomized controlled trials involving 710 patients were included. We considered any article comprising head-to-head evaluations of at least two of the seven focal regional modalities: continuous subcutaneous/local anesthetic wound infusion (CLAI), continuous erector spinae plane block (ESPB), thoracic epidural analgesia (EA), single-shot erector spinae plane block (ESPB), intrathecal morphine (ITM), quadratus lumborum block (QLB), or continuous thoracic paravertebral block (CTPVB). The primary outcome was postoperative pain scores at rest and movement. Secondary outcomes included morphine consumption at 24, 48, and 72 h; duration of inpatient stay; incidence of postoperative nausea/vomiting (PONV); and any adverse events.

For resting pain scores, pairwise meta-analysis of EA compared to CLAI demonstrated no significant difference at 24 h (SMD = -0.71; 95% CI -2.09, -0.67) and at 48 h postoperatively (SMD = -0.13, 95% CI -0.74, -0.48). However, during movement, EA compared to CLAI demonstrated a significant difference at 24 h (SMD = -1.71, 95% CI -2.26, -1.17) and 48 h (SMD = -0.99, 95% CI -1.46, -0.53) postoperatively. This study does not provide conclusions regarding morphine equivalents at 72 h, the incidence of PONV, or the duration of hospital stay due to the absence of pairwise meta-analysis among the included regional anesthesia techniques.

Among the seven regional anesthesia techniques for liver surgery, EA demonstrates strong analgesic efficacy but requires assessment of coagulation risk, while CESPB and QLB showcase a good safety profile but lack sufficient long-term evidence. This study offers comparative insights to guide clinical decisions rather than definite evidence of overall reliability or low risk associated with regional anesthesia.