Efficacy of Spinal Analgesia for Pain Management in Living Donor Hepatectomy: A Systematic Review

BackgroundLiving donor hepatectomy is a major surgical procedure associated with significant postoperative pain. Effective analgesia is essential to enhance recovery and ensure donor safety. Traditional approaches such as epidural analgesia are effective but may raise safety concerns due to perioperative coagulopathy. Spinal analgesia using intrathecal morphine (ITM) has emerged as a potential alternative, providing long-lasting pain relief with a favorable safety profile.MethodsThis systematic review was conducted following PRISMA guidelines and registered in PROSPERO (CRD420251149887). PubMed and EMBASE were searched from January 2000 to September 2025 for randomized and observational studies evaluating spinal analgesia in living donor hepatectomy. Outcomes included pain intensity, opioid consumption, and complications. Study quality was assessed using the Oxford Centre for Evidence-Based Medicine (OCEBM) levels and the RoB 2 tool.ResultsThe initial search revealed a total of 937 publications. After duplicate removal, 932 articles were eligible for screening from title and abstract, and 920 were excluded . The remaining 12 articles were then eligible for full-text review. Among these, 4 studies were excluded (abstract N = 1; letter to the editor or commentaries N = 1; no full text available N = 1; review N = 1). Eight studies involving 698 patients were included (seven randomized trials and one retrospective study). Spinal analgesia, mainly using 300-400 µg ITM, provided effective pain relief and reduced opioid consumption compared with intravenous patient-controlled analgesia, thoracic epidural analgesia, wound infiltration, and some fascial plane blocks. Adverse effects such as pruritus, nausea, and vomiting were common but mild and self-limiting; respiratory depression was rare.ConclusionsIntrathecal morphine provides effective and durable postoperative analgesia in living liver donors, reducing opioid use and avoiding the risks of epidural catheterization. Despite promising results, evidence remains limited by small sample sizes and study heterogeneity. High-quality multicenter trials are needed to define optimal dosing and integrate spinal analgesia into multimodal enhanced recovery protocols for donor hepatectomy.