Benefit of epidural analgesia for postoperative pain control after a Kasai Portoenterostomy: A ten‐year retrospective cohort study

• Published in: Pediatric anesthesia 2023-02, Vol.33 (2), p.154-159
• Main Authors: Bae, Evelyn, Ganesh, Arjunan, Flake, Alan W., Gurnaney, Harshad G.
• Format: Article
• Language: English
• Subjects: Analgesia, Epidural - methods; Analgesics, Opioid - therapeutic use; Biliary Atresia - surgery; Child; Cohort analysis; Cohort Studies; Confidence intervals; Epidural; Humans; Infant; infant postoperative pain management; Kasai portoenterostomy; Morphine; Narcotics; Pain management; Pain, Postoperative - drug therapy; Portoenterostomy, Hepatic - methods; Postoperative period; Retrospective Studies; thoracic epidural analgesia
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/pan.14583

Introduction Biliary atresia is a rare obstructive cholangiopathy that presents in infants. The Kasai portoenterostomy procedure, which reestablishes biliary drainage into the intestine, is a surgical procedure that has been found to improve survival with the native liver. The options for postoperative analgesia include systemic opioids and epidural analgesia. The primary objective of this study was to compare the postoperative systemic opioids used in morphine equivalents (mg/kg) on postoperative days 0 through 3 between patients who underwent a Kasai portoenterostomy and received a thoracic epidural infusion to those without thoracic epidural analgesia. Methods We conducted a retrospective cohort study of 91 infants with biliary atresia undergoing a Kasai portoenterostomy between January 1, 2009, and September 1, 2019, at the Children's Hospital of Philadelphia. Results Sixty‐three of the 91 patients (69%) had a continuous epidural catheter placed intraoperatively for postoperative analgesia. The total opioid requirement (morphine equivalents) for the first 72 h in the epidural group of (Mean (95% confidence interval): 0.52 mg/kg (0.38, 0.67 mg/kg) was lower than the non‐epidural group (Mean (95% confidence interval): 1.15 mg/kg (0.8, 1.48 mg//kg) for a difference in mean opioid requirement (95% confidence interval) of 0.63 mg/kg (0.32, 0.94 mg/kg). Patients in the non‐epidural group had higher rates of unplanned ICU admissions (36% non‐epidural group vs. 3.3% epidural group, difference in proportion (95% confidence interval) 32.7% (13, 52%), p