Background To assess the efficacy of ultrasound-guided regional nerve blocks (RNBs) in patients undergoing purely laparoscopic hepatectomy and their impact on postoperative recovery, providing evidence for anesthetic management within enhanced recovery after surgery (ERAS) protocols. Methods PubMed, Embase, Cochrane Library, Web of Science, and CNKI were searched through August 2025. Eligible studies were randomized controlled trials (RCTs) enrolling adults undergoing purely laparoscopic hepatectomy, comparing RNBs versus intravenous patient-controlled analgesia (PCIA) without RNB. The primary outcome was intraoperative opioid consumption standardized to morphine milligram equivalents (MME); secondary outcomes included 24-h postoperative pain visual analog scale (VAS) score, operative time, and postoperative nausea and vomiting (PONV). RCTs were analyzed as the primary analysis; cohort studies were included in sensitivity analyses. Statistical synthesis was performed using Review Manager 5.3 and Stata 12.0. Results Seven studies (four RCTs and three cohort studies) comprising 819 patients were included. Primary RCT analysis suggested that RNBs were associated with reduced intraoperative opioid consumption (MME; MME; MD = − 24.87, P = 0.03; I² = 74%), lower 24-h VAS scores (MD = − 0.46, P < 0.001), lower incidence of PONV (RR = 0.59, P = 0.009), and shorter operative time (MD = − 11.98 min, P = 0.04; I² = 0%). Sensitivity analyses (leave-one-out method) showed consistent associations for 24-h VAS (MD = − 0.46, P < 0.001), operative time (MD = − 10.34 min, P = 0.002), and PONV (RR = 0.69, P = 0.03) when cohort studies were included. Meta-regression (performed exploratorily due to limited study numbers) identified block type (P = 0.040) and local anesthetic dose (P = 0.098) as potential contributors to heterogeneity in opioid consumption, explaining 97.27% of variance. Visual inspection of funnel plots showed no significant asymmetry for key outcomes (24-h VAS, PONV), but small-study effects cannot be fully excluded for MME due to the small number of RCTs (n = 3). Conclusions Ultrasound-guided RNBs may provide effective analgesia in purely laparoscopic hepatectomy and are associated with reduced opioid use, lower PONV incidence, and shorter operative time—findings that align with ERAS principles. However, due to substantial heterogeneity, low GRADE certainty, and limited geographic diversity (mostly East Asian studies), results should be interpreted cautiously. Larger multicenter RCTs are needed to optimize RNB protocols and confirm benefits.

Analgesic efficacy of multiple regional nerve block techniques in laparoscopic hepatectomy: a systematic review and meta-analysis

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2026年1月17日

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Wen-jun Yuan,
Zhi-yong Wang,
Jun Pu,
Xin-cheng Huang

摘要

Background

To assess the efficacy of ultrasound-guided regional nerve blocks (RNBs) in patients undergoing purely laparoscopic hepatectomy and their impact on postoperative recovery, providing evidence for anesthetic management within enhanced recovery after surgery (ERAS) protocols.

Methods

PubMed, Embase, Cochrane Library, Web of Science, and CNKI were searched through August 2025. Eligible studies were randomized controlled trials (RCTs) enrolling adults undergoing purely laparoscopic hepatectomy, comparing RNBs versus intravenous patient-controlled analgesia (PCIA) without RNB. The primary outcome was intraoperative opioid consumption standardized to morphine milligram equivalents (MME); secondary outcomes included 24-h postoperative pain visual analog scale (VAS) score, operative time, and postoperative nausea and vomiting (PONV). RCTs were analyzed as the primary analysis; cohort studies were included in sensitivity analyses. Statistical synthesis was performed using Review Manager 5.3 and Stata 12.0.

Results

Seven studies (four RCTs and three cohort studies) comprising 819 patients were included. Primary RCT analysis suggested that RNBs were associated with reduced intraoperative opioid consumption (MME; MME; MD = − 24.87, P = 0.03; I² = 74%), lower 24-h VAS scores (MD = − 0.46, P < 0.001), lower incidence of PONV (RR = 0.59, P = 0.009), and shorter operative time (MD = − 11.98 min, P = 0.04; I² = 0%). Sensitivity analyses (leave-one-out method) showed consistent associations for 24-h VAS (MD = − 0.46, P < 0.001), operative time (MD = − 10.34 min, P = 0.002), and PONV (RR = 0.69, P = 0.03) when cohort studies were included. Meta-regression (performed exploratorily due to limited study numbers) identified block type (P = 0.040) and local anesthetic dose (P = 0.098) as potential contributors to heterogeneity in opioid consumption, explaining 97.27% of variance. Visual inspection of funnel plots showed no significant asymmetry for key outcomes (24-h VAS, PONV), but small-study effects cannot be fully excluded for MME due to the small number of RCTs (n = 3).

Conclusions

Ultrasound-guided RNBs may provide effective analgesia in purely laparoscopic hepatectomy and are associated with reduced opioid use, lower PONV incidence, and shorter operative time—findings that align with ERAS principles. However, due to substantial heterogeneity, low GRADE certainty, and limited geographic diversity (mostly East Asian studies), results should be interpreted cautiously. Larger multicenter RCTs are needed to optimize RNB protocols and confirm benefits.