Regional anaesthesia techniques in liver and kidney transplantation: a narrative review in donors and recipients

Abstract

Advances in surgical techniques and perioperative care have driven increasing interest in regional anaesthesia as part of multimodal analgesia strategies. In liver and kidney transplantation, however, the adoption of regional techniques remains limited due to concerns regarding altered coagulation, cardiovascular instability, and graft perfusion. This narrative review aims to synthesize current evidence on the feasibility, safety, and clinical utility of neuraxial and fascial plane blocks in both transplant recipients and living donors. A narrative review of the literature was conducted, focusing on regional anaesthesia techniques used in transplantation. The review integrates anatomical considerations, sources of postoperative pain, patient-specific comorbidities, and clinical evidence related to neuraxial anaesthesia and ultrasound-guided fascial plane blocks, including erector spinae plane block, quadratus lumborum block, transversus abdominis plane block, modified thoracoabdominal nerve block, external oblique intercostal block, and emerging techniques. Neuraxial anaesthesia can provide effective analgesia in carefully selected transplant patients, particularly in living donors, but its use is constrained by dynamic coagulation abnormalities and hemodynamic instability, especially in recipients. Fascial plane blocks offer a favorable risk-benefit profile, providing effective somatic and, in some cases, visceral analgesia while preserving hemodynamic stability and minimizing bleeding risk. Evidence supports their opioid-sparing effects and feasibility across a range of transplant procedures. Regional anaesthesia represents a valuable component of multimodal analgesia in liver and kidney transplantation when tailored to surgical incision patterns, sources of pain, and patient-specific physiological considerations. Fascial plane blocks, in particular, appear well suited to transplant populations and may facilitate enhanced recovery while maintaining graft-protective priorities.