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

This network meta-analysis (NMA) was conducted to evaluate the analgesic efficacy of various nerve blocks in patients undergoing open partial hepatectomy.

We retrieved randomized controlled trials (RCTs) assessing different peripheral nerve blocks in patients undergoing open partial hepatectomy from databases including PubMed, Embase, Web of Science, and the Cochrane Library, spanning from inception until December 2025. The NMA was performed using STATA 17.0 software.

A total of 17 RCTs involving 1056 patients and 8 techniques were included in the analysis. Continuous Transversus Abdominis Plane Block (cTAPB) and continuous Thoracic Paravertebral Block (cTPVB) significantly decreased morphine consumption within 24 hours. The Erector Spinae Plane Block (ESPB) and Thoracoabdominal Nerve Block (TANB) reduced resting Visual Analog Scale (VAS) scores at 6 hours. At 12 hours, resting VAS scores were decreased by ESPB and subcostal Transversus Abdominis Plane Block (sTAPB), while at 24 hours, resting VAS scores were lowered by TANB and cTAPB. For movement VAS scores, reductions were observed at 6 hours with ESPB and cTPVB, at 12 hours with ESPB and sTAPB, and at 24 hours with TANB and External Oblique Intercostal Plane Block (EOIPB). Additionally, ESPB and TANB were associated with a decrease in the incidence of postoperative nausea and vomiting (PONV).

While cTAPB and cTPVB ranked higher in terms of reducing 24-hour morphine consumption, the clinical difference between these techniques and other interventions was small. ESPB was more likely to reduce VAS within the first 12 hours and the PONV incidence. Nevertheless, the certainty of evidence for these findings remains low to moderate, and further high-quality randomized controlled trials are warranted to confirm their clinical utility.

The studies included in our review exhibited inconsistencies in study design and analgesia protocols, which may introduce bias into our findings. The results may not be directly applicable to laparoscopic procedures. The absence of these unpublished data or ongoing trials could limit the comprehensiveness of our analysis.