Research report: Multimodal analgesic regimen is associated with earlier bowel recovery in infants undergoing liver transplantation: a cohort study

Infants who received a combination of sufentanil, esketamine, and dexmedetomidine for pain control after liver transplantation passed their first bowel movement roughly 20.6 hours sooner than infants given morphine alone, according to a retrospective cohort study conducted at Renji Hospital in Shanghai, China.

The study, published in Frontiers in Medicine, reviewed the medical records of 82 infants who underwent liver transplantation at the hospital between September 2022 and March 2023. The infants ranged in age from 4 to 12 months, and their mean preoperative pediatric end-stage liver disease (PELD) scores were 18.7 and 21.9 in the two comparison groups.

Patients were divided into two groups based on the postoperative analgesia regimen they received. The morphine group received morphine only, while the multimodal analgesia group received sufentanil in combination with esketamine and dexmedetomidine. The researchers then compared bowel recovery and other postoperative outcomes between the two regimens.

Using general linear model analysis, the team found that the multimodal analgesia group had a significantly shorter time to first bowel movement and a shorter duration of mechanical ventilation than the morphine-only group. Multivariate analysis further indicated that the use of multimodal analgesia was associated with an acceleration of time to first defecation by approximately 20.6 hours.

The authors concluded that, compared with morphine alone, the combination of sufentanil, esketamine, and dexmedetomidine for postoperative analgesia in liver transplant infants appears more beneficial for bowel recovery and facilitates early postoperative extubation.

However, the study has important limitations that shape how the results should be interpreted. It was a single-center retrospective cohort study, meaning the researchers analyzed existing medical records rather than randomly assigning patients to one analgesia regimen or the other. With 82 infants in total, the number of patients in each group was modest, and retrospective designs cannot rule out the influence of factors that differed between the groups beyond the analgesia regimen itself.

The reported differences in PELD scores between the groups, with means of 18.7 and 21.9, suggest that baseline disease severity may not have been identical, although the study’s abstract does not report whether this difference was statistically significant or how it was handled in the adjusted analyses. Readers should therefore treat the 20.6-hour estimate as an association observed in this specific cohort rather than a definitive causal effect established by a randomized trial.

As the authors note, the combination was associated with both earlier bowel recovery and earlier extubation in these infant liver transplant recipients.

Subject of Research: Postoperative analgesia regimens and bowel recovery in infants undergoing liver transplantation

Article Title: Multimodal analgesic regimen is associated with earlier bowel recovery in infants undergoing liver transplantation: a cohort study

Article References: Zhu, L., He, J., Gao, L., Deng, Y., & Qi, B. (2026). Multimodal analgesic regimen is associated with earlier bowel recovery in infants undergoing liver transplantation: a cohort study. Frontiers in Medicine, 13, Article 1962570. https://doi.org/10.3389/fmed.2026.1962570

Image Credits: AI Generated

DOI: 10.3389/fmed.2026.1962570

Keywords: liver transplantation, infants, multimodal analgesia, morphine, sufentanil, esketamine, dexmedetomidine, bowel recovery, mechanical ventilation, retrospective cohort study, pediatric surgery, postoperative pain