ArticleFrontiers in pediatrics2026
Effects of multimodal analgesia with combined quadratus lumborum block on enhanced recovery after Kasai portoenterostomy in infants with biliary atresia: a retrospective cohort study.
Article in Frontiers in pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Biliary atresia is a severe hepatobiliary disease in infancy, and Kasai surgery is the standard surgical treatment. However, the marked postoperative pain and opioid-related adverse effects may affect early recovery. This study aimed to evaluate the effect of multimodal analgesia combined with quadratus lumborum block (QLB) on early recovery after Kasai surgery in infants with biliary atresia. Methods: In this single-center retrospective cohort study76 infants who underwent Kasai surgery were included, of whom 39 received general anesthesia combined with ultrasound-guided bilateral QLB (GA + QLB group) and 37 received general anesthesia alone (GA group). The primary outcome was postoperative extubation time. Secondary outcomes included intraoperative opioid exposure expressed as morphine milligram equivalents (MME), FLACC pain scores at 2, 6, 12, and 24 h after surgery, postoperative analgesic strategy in the ICU, postoperative nausea and vomiting (PONV), and other recovery indicators. Linear mixed-effects models were used to analyze the postoperative pain trajectory, and inverse probability of treatment weighting (IPTW) and multivariable regression were used for sensitivity analyses. Results: Compared with the GA group, the GA + QLB group had a significantly shorter postoperative extubation time [5.00 (3.00, 10.50) vs 24.00 (20.00, 35.00) min, Conclusion: In infants undergoing Kasai surgery for biliary atresia, multimodal analgesia combined with quadratus lumborum block was associated with faster extubation, reduced intraoperative opioid exposure, improved postoperative pain control, and a lower incidence of PONV. This strategy may provide an effective and safe perioperative analgesic option for this vulnerable population.
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