Peripheral Nerve Blocks Following Open Hepatectomy: A Systematic Review and Network Meta-Analysis.

Area of Science:

• Anesthesiology and Pain Management
• Surgical Oncology
• Evidence-Based Medicine

Background:

• Open partial hepatectomy is associated with significant postoperative pain.
• Effective analgesia is crucial for patient recovery and reducing complications.
• Various nerve block techniques are employed to manage pain after hepatectomy.

Purpose of the Study:

• To evaluate and compare the analgesic efficacy of different nerve blocks for open partial hepatectomy.
• To synthesize evidence from randomized controlled trials (RCTs) using network meta-analysis (NMA).

Main Methods:

• Systematic search of PubMed, Embase, Web of Science, and Cochrane Library databases until December 2025.
• Inclusion of 17 RCTs with 1056 patients and 8 distinct nerve block techniques.
• Network meta-analysis performed using STATA 17.0 software.

Main Results:

• Continuous Transversus Abdominis Plane Block (cTAPB) and continuous Thoracic Paravertebral Block (cTPVB) significantly reduced 24-hour morphine consumption.
• Erector Spinae Plane Block (ESPB) and Thoracoabdominal Nerve Block (TANB) effectively reduced resting and movement Visual Analog Scale (VAS) pain scores at various time points (6, 12, and 24 hours).
• ESPB and TANB demonstrated a reduction in the incidence of postoperative nausea and vomiting (PONV).

Conclusions:

• While cTAPB and cTPVB showed the greatest reduction in morphine consumption, the clinical differences were marginal.
• ESPB appears promising for early pain relief and reducing PONV incidence.
• The certainty of evidence is low to moderate, necessitating further high-quality RCTs to confirm clinical utility.