{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T16:01:35Z","timestamp":1779379295729,"version":"3.53.1"},"reference-count":16,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,11,2]],"date-time":"2022-11-02T00:00:00Z","timestamp":1667347200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty\u2010three 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\u2009h in the epidural group of (Mean (95% confidence interval): 0.52\u2009mg\/kg (0.38, 0.67\u2009mg\/kg) was lower than the non\u2010epidural group (Mean (95% confidence interval): 1.15\u2009mg\/kg (0.8, 1.48\u2009mg\/\/kg) for a difference in mean opioid requirement (95% confidence interval) of 0.63\u2009mg\/kg (0.32, 0.94\u2009mg\/kg). Patients in the non\u2010epidural group had higher rates of unplanned ICU admissions (36% non\u2010epidural group vs. 3.3% epidural group, difference in proportion (95% confidence interval) 32.7% (13, 52%),<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.01). A higher percentage of patients in the non\u2010epidural group had a postoperative oxygen requirement (32.1% vs. 11.3%, difference in proportion (95% confidence interval) 21% (2, 40%),<jats:italic>p<\/jats:italic>\u00a0=\u00a0.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In our cohort study, continuous thoracic epidural analgesia in patients undergoing a Kasai portoenterostomy was associated with lower postoperative opioid use. We also observed that the epidural group had a lower ICU admission rate and a lower rate of postoperative supplemental oxygen requirement over the first three postoperative days.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.14583","type":"journal-article","created":{"date-parts":[[2022,10,21]],"date-time":"2022-10-21T13:04:12Z","timestamp":1666357452000},"page":"154-159","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Benefit of epidural analgesia for postoperative pain control after a Kasai Portoenterostomy: A ten\u2010year retrospective cohort study"],"prefix":"10.1111","volume":"33","author":[{"given":"Evelyn","family":"Bae","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Valley Hospital New Jersey Ridgewood USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjunan","family":"Ganesh","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia and Perelman School of Medicine University of Pennsylvania Pennsylvania Philadelphia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan W.","family":"Flake","sequence":"additional","affiliation":[{"name":"Department of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1132-1291","authenticated-orcid":false,"given":"Harshad G.","family":"Gurnaney","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia and Perelman School of Medicine University of Pennsylvania Pennsylvania Philadelphia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,11,2]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000000755"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1007164"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2003.12.014"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2000.00579.x"},{"issue":"2","key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1046\/j.1460-9592.2002.0810a.x-i1","article-title":"Epidural analgesia for patients undergoing hepatic portoenterostomy (Kasai procedure)","volume":"12","author":"Seefelder C","year":"2002","journal-title":"Paediatr 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Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pan.14583","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pan.14583","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pan.14583","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,29]],"date-time":"2023-11-29T09:59:43Z","timestamp":1701251983000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pan.14583"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,2]]},"references-count":16,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,2]]}},"alternative-id":["10.1111\/pan.14583"],"URL":"https:\/\/doi.org\/10.1111\/pan.14583","archive":["Portico"],"relation":{},"ISSN":["1155-5645","1460-9592"],"issn-type":[{"value":"1155-5645","type":"print"},{"value":"1460-9592","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,2]]},"assertion":[{"value":"2021-11-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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