Title: Regional anesthesia for pediatric liver transplant patients: a mini review
Source: Pediatric Transplantation 2026, 30 (1): e70258
Date of publication: January 2026
Publication type: Review article
Abstract: Optimizing postoperative analgesia in pediatric liver transplantation remains challenging due to the balance between effective pain control, opioid-related adverse effects, and the risks of neuraxial techniques in coagulopathic patients. Regional anesthesia has gained attention as a potential opioid-sparing adjunct in this setting. This concise review aimed to systematically synthesize evidence on regional anesthesia techniques for pediatric liver transplant recipients. A concise review was conducted in a systematic method following PRISMA principles. Comprehensive searches were performed on February 21, 2025, using PubMed/MEDLINE and Scopus to identify studies evaluating regional anesthesia in pediatric liver transplantation. Inclusion criteria encompassed original studies involving pediatric liver transplant recipients receiving regional analgesia. Two reviewers independently screened titles, abstracts, and full texts, with discrepancies resolved by consensus. Six studies met inclusion criteria, encompassing 55 pediatric liver transplant patients (18 controls). Reported regional techniques included erector spinae plane (ESP) blocks (n = 24), thoracic epidural analgesia (TEA) (n = 4), and quadratus lumborum (QL) blocks (n = 9). Across studies, regional anesthesia was associated with decreased perioperative opioid use, early extubation in the operating room, and faster return of bowel function. ESP and QL blocks demonstrated favorable safety profiles, while TEA-performed only after confirming normal coagulation-was safely implemented without complications. Regional anesthesia may be beneficial as part of multimodal analgesia in carefully selected pediatric liver transplant recipients by reducing opioid exposure and supporting early recovery. However, evidence remains limited by small sample sizes and heterogeneous methodologies. Larger, prospective trials are needed to refine patient selection, establish standardized protocols, and confirm safety and efficacy.
