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Enhancing Recovery After Kasai Portoenterostomy With Epidural Analgesia
Hannah M Phelps1, Jamie R Robinson2, Heidi Chen3
1Vanderbilt University School of Medicine, Nashville, TN; Surgical Outcomes Center for Kids, Monroe Carell, Jr. Children's Hospital, Nashville, TN.
The Journal of Surgical Research
|July 6, 2019
Summary
Epidural analgesia safely reduces pain and opioid use in infants undergoing Kasai portoenterostomy for biliary atresia. This approach also shortens hospital stays and may decrease the need for mechanical ventilation, improving recovery.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Gastroenterology
Background:
- Biliary atresia (BA) is a rare infantile obstructive cholangiopathy.
- Kasai portoenterostomy (PE) is a surgical procedure to improve survival in infants with BA.
- The use of epidural analgesia for pain management in infants undergoing PE is not well-established.
Purpose of the Study:
- To evaluate the safety and efficacy of epidural analgesia in infants undergoing Kasai portoenterostomy for biliary atresia.
- To compare postoperative outcomes between infants who received epidural analgesia and those who did not.
Main Methods:
- Retrospective review of 47 infants who underwent PE for BA between 2001 and 2016.
- Comparison of outcomes including pain scores, opioid administration, mechanical ventilation, bowel function, and length of hospital stay between infants with and without epidural analgesia.
Main Results:
- Infants receiving epidural analgesia had significantly lower pain scores and reduced systemic opioid requirements in the first 96 hours postoperatively.
- Epidural use was associated with a higher rate of extubation before leaving the operating room and shorter hospital stays.
- No significant difference was found in the time to first bowel movement or oral feed. No major complications related to epidural catheters were observed.
Conclusions:
- Epidural analgesia is a safe and effective method for pain control in infants undergoing PE for BA.
- This technique minimizes systemic opioid needs, reduces the requirement for mechanical ventilation, and shortens hospital stays, thereby enhancing postoperative recovery.
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