[Methods of regional analgesia during hepatopancreatobiliary surgeries].

Abstract

Hepatopancreatobiliary surgeries are complex procedures associated with significant perioperative pain. Adequate pain relief improves patient comfort, contributes to faster recovery, and reduces the risk of complications. While thoracic epidural analgesia remains the first-line option for open pancreatic surgeries, its use in liver resections is debated. There is growing experience and increasing emphasis on alternative neuraxial and regional techniques. We aimed to perform a systematic review of randomized, controlled trials focused on neuraxial and regional anesthesia methods in hepatopancreatobiliary surgery. A structured PubMed® search was performed. We reviewed 47 randomized, controlled studies. Epidural analgesia continues to provide excellent pain relief, but there is a higher need for volume replacement and vasoactive agents. Intrathecal morphine administration is a viable alternative, particularly for laparoscopic procedures, though it is associated with a higher incidence of itching and nausea. Regional anesthesia techniques, such as erector spinae and transversus abdominis plane blocks, effectively reduce postoperative opioid requirements and related side effects, but their analgesic effects are inferior to epidural analgesia. Results from paravertebral and quadratus lumborum blocks are inconsistent, with their effectiveness not yet clearly established. Continuous wound infusion catheters are increasingly used to reduce opioid consumption. The optimal choice of technique is a multidisciplinary decision, considering patient risks, comorbidities, and surgical methods, with an increasing focus on novel approaches. Orv Hetil. 2025; 166(26): 1003–1016.