Journal article
Enhancing Recovery After Kasai Portoenterostomy With Epidural Analgesia
The Journal of surgical research, Vol.243, pp.354-362
11/2019
DOI: 10.1016/j.jss.2019.05.059
PMCID: PMC6773489
PMID: 31277012
Abstract
Biliary atresia (BA) is a rare obstructive cholangiopathy that presents in early infancy. The Kasai portoenterostomy (PE) improves survival with the native liver. Epidural analgesia is an appealing option to control pain in this fragile patient population, yet its safety, efficacy, and potential benefits remain unproven.
Patients undergoing PE for BA between 2001 and 2016 at a single institution were identified by ICD codes. Preoperative laboratories, procedure details, and recovery outcomes were reviewed retrospectively. Outcomes of interest were need for postoperative mechanical ventilation, pain scores, normalized opioid administration, return of bowel function, and length of hospital stay after PE.
Of 47 infants undergoing PE for BA, 25 received epidural analgesia, and 22 did not. Infants with epidurals received less systemic opioids over the first 96 h postoperatively than those without (P < 0.001). Epidurals were associated with lower pain scores between 6 and 30 h postoperatively (P = 0.01 to 0.04), during which the highest median 6-h interval pain score was 0.2 (IQR 0-1.3) for patients with epidurals yet 2.1 (IQR 1.2-3.3) for patients without. Patients with epidurals (88%, n = 22) were more commonly extubated before leaving the operating room than those without (59%, n = 13; P = 0.02). No significant difference was observed in time to first bowel movement (P = 0.48) or first oral feed (P = 0.81). However, infants with epidurals had shorter hospital stays after PE than those without (6 d [IQR 5-7] versus 8 d [IQR 6.3-11], P = 0.01). No major complications were associated with epidural catheters.
Epidural analgesia in patients undergoing PE for BA appears safe and effectively controls pain while minimizing the need for systemic opioids. Reduced need for mechanical ventilation postoperatively and shortened hospital stays serve as further evidence for using epidurals to enhance recovery after PE.
Details
- Title: Subtitle
- Enhancing Recovery After Kasai Portoenterostomy With Epidural Analgesia
- Creators
- Hannah M Phelps - Vanderbilt University School of Medicine, Nashville, TNJamie R Robinson - Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TNHeidi Chen - Surgical Outcomes Center for Kids, Monroe Carell, Jr. Children's Hospital, Nashville, TNTwila R Luckett - Pediatric Pain Service, Monroe Carell, Jr. Children's Hospital, Nashville, TNPatricia C Conroy - Vanderbilt University School of Medicine, Nashville, TNLynette A Gillis - Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TNStephen R Hays - Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TNHarold N Lovvorn - Surgical Outcomes Center for Kids, Monroe Carell, Jr. Children's Hospital, Nashville, TN
- Resource Type
- Journal article
- Publication Details
- The Journal of surgical research, Vol.243, pp.354-362
- DOI
- 10.1016/j.jss.2019.05.059
- PMID
- 31277012
- PMCID
- PMC6773489
- NLM abbreviation
- J Surg Res
- ISSN
- 0022-4804
- eISSN
- 1095-8673
- Publisher
- Elsevier Inc
- Grant note
- DOI: 10.13039/100000002, name: National Institutes of Health
- Language
- English
- Date published
- 11/2019
- Academic Unit
- Stead Family Department of Pediatrics; Anesthesia
- Record Identifier
- 9984007289502771
Metrics
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