TRANSPLANTATION ANESTHESIA (KG BELANI, SECTION EDITOR)
Regional Analgesia Techniques for Adult Patients Undergoing Solid
Kamen V. Vlassakov
Published online: 20 April 2018
Springer Science+Business Media, LLC, part of Springer Nature 2018
Purpose of review Organ transplantations often include major incisions that can be associated with significant postoperative pain.
While these patients may theoretically benefit from regional anesthesia, many practitioners have avoided such techniques due to
considerations, such as a low perceived benefit if the patient stays intubated postoperatively and concerns about the coagulation
status in patients with end-stage liver/kidney disease and perioperative use of anticoagulation.
Recent findings With refinements in both surgical (laparoscopic and robot-assisted procedures) and regional anesthesia tech-
niques (ultrasound guidance), new interest in nerve blocks for organ transplantation has emerged and flourished.
Summary While neuraxial anesthesia continues to be used, albeit less frequently for solid organ transplantation, peripheral nerve
blocks and paravertebral blocks, in contrast, have increasingly been employed and studied. Specifically, transversus abdominis
plane blocks and related fascial plane block techniques are safe to perform and easy to learn. Continuous peripheral nerve blocks
are starting to rival the versatility and the widespread use of epidural analgesia with comparable results and lower risk, but
validation in various settings is still needed.
Keywords Regional anesthesia
Peripheral nerve block
Regional anesthesia has long been a powerful tool employed
by anesthesiologists to relieve pain and reduce opioid needs.
Technology-driven advances such as ultrasound guidance
have lead to a significant expansion of neural blockade use
in thoracic and abdominal surgery that goes well beyond the
more traditional continuous epidural analgesia.
This review will focus on the current practice and recent
advances in regional anesthesia techniques employed for solid
organ transplantation, including the liver, kidney, and pancre-
as transplantation Table 1.
Liver transplantations are major abdominal surgeries. The uti-
lized incisions (“Mercedes sign,” J-shaped subcostal, upper
midline) tend to be large, painful, and, due to their location,
significantly affect respiratory effort and cough effectiveness.
Depending on the postoperative plan, patients that are
extubated in the operating room or shortly after intensive care
unit arrival may theoretically benefit from regional anesthesia.
However, while continuous epidural and paravertebral block-
ade should provide optimal pain control, such techniques
might prove extremely difficult to implement safely in this
patient population as advanced liver disease and cirrhosis are
strongly associated with coagulopathy. Furthermore, liver
transplantation surgery is associated with significant blood
loss and occasional extensive blood product transfusion,
This article is part of the Topical Collection on Transplantation
* Benjamin Kloesel
Kamen V. Vlassakov
Department of Anesthesiology, University of Minnesota, B515 Mayo
Building, 420 Delaware Street SE, Minneapolis, MN 55455, USA
Department of Anesthesiology, Perioperative and Pain Medicine,
Brigham and Women’s Hospital/Harvard Medical School, 75 Francis
Street, Boston, MA 02115, USA
Current Anesthesiology Reports (2018) 8:217–224