Continuous External Oblique Interfascial Plane Block for Postoperative Analgesia in an Infant Undergoing Kasai Portoenterostomy with Coagulation Abnormality: A Case Report

Kasai portoenterostomy for biliary atresia is associated with significant postoperative pain in neo-nates and infants. Neuraxial analgesia may be contraindicated in the presence of coagulation abnor-malities. The external oblique interfascial plane (EOIP) block is a recently described fascial plane block that provides abdominal wall analgesia while avoiding neuraxial risks.
A 6-week-old, 3.4-kg infant with biliary atresia and isolated prolongation of activated partial thromboplastin time underwent Kasai portoenterostomy. Thoracic epidural analgesia was avoided due to bleeding risk. Following induction of general anaesthesia, an ultrasound-guided EOIP block catheter was placed, and intermittent local anaesthetic boluses were administered postoperatively as part of multimodal analgesia. Pain scores remained low, opioid requirements were minimal, and no block-related complications occurred. Continuous EOIP block through a catheter may provide a safe and effective alternative to neuraxial analgesia in infants with coagulation abnormalities undergoing upper abdominal surgery.