Regional Anesthesia for Pediatric Liver Transplant Patients: A Mini Review

Area of Science:

• Anesthesiology
• Pediatric Surgery
• Transplantation Medicine

Background:

• Postoperative pain management in pediatric liver transplantation is complex, balancing effective analgesia with opioid risks and neuraxial technique contraindications in coagulopathic patients.
• Regional anesthesia is explored as an opioid-sparing strategy to improve outcomes in this vulnerable population.

Purpose of the Study:

• To systematically review the existing evidence on the use and effectiveness of regional anesthesia techniques in pediatric liver transplant recipients.

Main Methods:

• A systematic review following PRISMA guidelines was conducted.
• Searches of PubMed/MEDLINE and Scopus identified studies on regional anesthesia in pediatric liver transplantation.
• Six studies involving 55 patients were included, analyzing erector spinae plane (ESP), thoracic epidural analgesia (TEA), and quadratus lumborum (QL) blocks.

Main Results:

• Regional anesthesia was associated with reduced perioperative opioid consumption, earlier extubation, and faster bowel function recovery.
• ESP and QL blocks showed good safety profiles.
• Thoracic epidural analgesia was safely used in patients with normal coagulation.

Conclusions:

• Regional anesthesia may be a valuable component of multimodal analgesia for selected pediatric liver transplant recipients, aiding in opioid reduction and early recovery.
• Limited evidence due to small sample sizes and varied methods necessitates larger prospective trials to standardize protocols and confirm benefits.