title: Age- and procedure-specific differences of epidural analgesia in children--a database analysis.
abstract: OBJECTIVE
  Several audits demonstrated the safety of epidural catheters in children undergoing surgery. Within the present data analysis, we investigated whether older compared with younger children and children with specific types of surgical procedures might report higher pain scores.
  
  
  METHODS
  All children (0-18 years) treated with an epidural catheter for postoperative pain treatment between March 2006 and December 2010 at the University Hospital of Muenster (Germany) were included. Postoperative pain intensities, the number of patients with the need for additional opioids, and catheter-related complications during placement and early postoperative period were analyzed.
  
  
  RESULTS
  Data of 830 children receiving an epidural catheter (Nthoracic/lumbar = 691; Ncaudal = 139) were included. Adolescents (12-18 years) treated with a thoracic/lumbar epidural had higher pain scores compared with preschoolers and school children (P < 0.05) and received less additional systemic opioids (P < 0.001). In the thoracic/lumbar epidural group, children undergoing spine surgery showed comparable pain scores with those undergoing thoracic procedures, but had higher pain scores than children undergoing abdominal or extremity surgery (P < 0.05). However, children undergoing spine surgery received less additional opioids, but this was only significant at the first postoperative day (P = 0.032).
  
  
  CONCLUSIONS
  This database analysis demonstrated that older children and children undergoing thoracic or spine surgery reported significant higher pain scores most likely because they received less additional opioids. Therefore, a more "aggressive" pain treatment (including opioids on demand under appropriate monitoring) might further improve postoperative care.
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Muenster, Germany; Department of Anaesthesiology, University Hospital of Wuerzburg, Wuerzburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Schnabel
authors.forename: Navina M
authors.initials: NM
authors.lastname: Thyssen
authors.forename: Christiane
authors.initials: C
authors.lastname: Goeters
authors.forename: Hua
authors.initials: H
authors.lastname: Zheng
authors.forename: Peter K
authors.initials: PK
authors.lastname: Zahn
authors.forename: Hugo
authors.initials: H
authors.lastname: Van Aken
authors.forename: Esther M
authors.initials: EM
authors.lastname: Pogatzki-Zahn
mesh_terms: D000293:Adolescent; D000367:Age Factors; D015360:Analgesia, Epidural / Q000295:instrumentation / Q000379:methods*; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010147:Pain Measurement / Q000295:instrumentation / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D013223:Statistics as Topic / Q000379:methods*
keywords: Age; Children; Epidural Analgesia; Postoperative Pain Treatment; Procedure-Specific Pain Treatment