title: Perioperative epidural analgesia in children undergoing major abdominal tumor surgery--a single center experience.
abstract: OBJECTIVE
  The purpose of this study was to assess the use of continuous epidural analgesia in pediatric patients undergoing major abdominal tumor surgery.
  
  
  METHODS
  Children undergoing major abdominal tumor surgery at our institution between 2008 and 2012 (n=40) received continuous epidural analgesia via an epidural catheter. Surgical trauma scores, pain scores, and clinical data of the children were compared to a pair-matched historical control group operated on between 2002 and 2007 without epidural analgesia.
  
  
  RESULTS
  Pain levels in the study group on day 1 and 3 after surgery were lower compared to the control group. The differences did, however, not reach statistical significance (p=0.15 and 0.09). Children in the study group received significantly fewer additional doses of piritramide or morphine (45% versus 82%, p<0.001). Despite significantly higher surgical trauma scores in the study group (p=0.018), there were no statistical differences regarding clinical parameters, such as mechanical ventilation time, time on intensive care unit, and total hospital stay. There were no catheter-related complications.
  
  
  CONCLUSIONS
  Continuous epidural analgesia is beneficial for children undergoing complex abdominal tumor surgery with regard to pain levels, postoperative recovery, and general clinical course. Expertise of the managing team, a careful patient selection, and a continuous quality assessment are essential for success.
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany. Electronic address: steven.warmann@med.uni-tuebingen.de.
authors.forename: Steven W
authors.initials: SW
authors.lastname: Warmann
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Lang
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Fideler
authors.affiliation: Department of Clinical Epidemiology and Applied Biometry, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Blumenstock
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Schlisio
authors.affiliation: Department of Pediatric Cardiology, Pulmology and Intensive Care, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Kumpf
authors.affiliation: Department of Pediatric Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Ebinger
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Seitz
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Fuchs
mesh_terms: D000008:Abdominal Neoplasms / Q000601:surgery*; D015360:Analgesia, Epidural / Q000379:methods*; D000700:Analgesics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D019990:Perioperative Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000700:Analgesics
keywords: Abdominal surgery; Catheter; Continuous epidural analgesia; Epidural; Pain scores; Pediatric solid tumors