Impact of early postoperative pain management strategies on complication rates in infants with biliary atresia after Kasai portoenterostomy

Abstract

BACKGROUND

Biliary atresia is a progressive fibro-obliterative cholangiopathy of infancy treated primarily by Kasai portoenterostomy (KPE) to restore bile flow. Postoperative pain control remains challenging and may affect recovery and prognosis.

AIM

To assess whether an early, structured pain management protocol reduces complications and improves short-term outcomes after KPE in infants.

METHODS

This study included 120 infants with biliary atresia who underwent KPE at The First Affiliated Hospital of the University of South China from March 2022 to March 2025. Using random allocation, infants were divided into an observation group (n = 60) receiving multimodal analgesia (ultrasound-guided transversus abdominis plane block plus patient-controlled intravenous analgesia), and a control group (n = 60) receiving on-demand opioid analgesia. Groups were compared for postoperative complications, Faces, Legs, Activity, Cry, and Consolability and Ramsay scores, opioid use, recovery indicators, and 6-month native liver survival.

RESULTS

The observation group showed lower rates of postoperative cholangitis, pulmonary infection, and total complications than the control group (P < 0.05). Face, Legs, Activity, Cry, Consolability scores at 6-72 hours postoperatively were significantly lower in the observation group, with a marked group-time interaction. Ramsay scores were higher at 6 hours and 12 hours but lower at 24 hours and 48 hours, also demonstrating significant group-time interaction (P < 0.05). The observation group required less opioid use within 48 hours and had shorter times to first defecation, Pediatric Intensive Care Unit (PICU) stay, and total hospitalization (P < 0.05). Six-month native liver survival was higher in the observation group (76.7%, 46/60) than in the control group (61.7%, 37/60; P < 0.05).

CONCLUSION

Early multimodal analgesia combining ultrasound-guided transversus abdominis plane block and patient-controlled intravenous analgesia provides safer, more effective analgesia, reduces complications, and enhances postoperative recovery and native liver survival after KPE.

Keywords: Pediatric biliary atresia; Kasai portoenterostomy; Postoperative pain; Multimodal analgesia; Complications

Core Tip: This study demonstrates that an early multimodal analgesia protocol, utilizing ultrasound-guided transversus abdominis plane block combined with patient-controlled intravenous analgesia, is superior to conventional on-demand opioid analgesia for infants after Kasai surgery. This approach not only provides superior and safer pain control but is also associated with reduced postoperative complications (particularly cholangitis and pulmonary infection), faster recovery, and significantly improved 6-month native liver survival.