Background and Aims Patients with liver disease present a challenge for perioperative analgesia. Peripheral nerve blocks have a good risk benefit balance and may lower the need for perioperative analgesics.

Methods We present three paediatric cases with hepatic compromise in which peripheral blocks under general anaesthesia have provided satisfactory, uncomplicated analgesia and lowered the need for systematic agents

Results A 16-months-old 9kg baby, was scheduled for primary resection of hepatoblastoma. The extended right hepatectomy required a right subcostal incision along with a left subcostal extension. Ultrasound guided bilateral subcostal TAP blocks were performed, using Ropivacaine 0.1%, 0.4 ml/kg on the right and 0.2 ml/kg on the left side. A preperitoneal multi-holed catheter was introduced by the surgeon at the end of the surgery and Ropivacaine 0.1%, infusion was started at 0.3 ml/kg/h. Postoperatively only 4 doses of paracetamol were administered during the first 48 hours.

A postoperative omphalocele reconstruction was scheduled on a 4-year-old 15.5 kg girl with Alagille’s syndrome, an inherited disorder with cholestasis. Single shot ultrasound guided bilateral rectus sheath block with 0.8 ml/kg Ropivacaine 0.1% with Dexmedetomidine 0.3mcg/kg provided analgesia for 10 hours. One rescue dose of paracetamol was required the first 24 hours.

A 17-year-old 102kg boy with Orthotopic Liver Transplantation for Ornithine Transcarbamylase Deficiency was scheduled for posterior open hamstring release. Popliteal Sciatic nerve block under ultrasound guidance with 20 ml Ropivacaine 0.375% with Dexmedetomidine 30 mcg was performed. No other analgesia was required for the first 24 hours.

Conclusions Peripheral nerve blocks are a valuable tool in the perioperative management of liver disease paediatric patients.