Schnabel Alexander, Thyssen Navina M, Goeters Christiane, Zheng Hua, Zahn Peter K, Van Aken Hugo, Pogatzki-Zahn Esther M
Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Muenster, Germany; Department of Anaesthesiology, University Hospital of Wuerzburg, Wuerzburg, Germany.
Pain Med. 2015 Mar;16(3):544-53. doi: 10.1111/pme.12633. Epub 2015 Jan 19.
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.
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.
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).
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.
多项审计证明了硬膜外导管在接受手术的儿童中的安全性。在本次数据分析中，我们调查了年龄较大的儿童与年龄较小的儿童相比，以及接受特定类型外科手术的儿童是否会报告更高的疼痛评分。
纳入2006年3月至2010年12月在德国明斯特大学医院接受硬膜外导管用于术后疼痛治疗的所有儿童（0 - 18岁）。分析术后疼痛强度、需要额外使用阿片类药物的患者数量以及置管期间和术后早期与导管相关的并发症。
纳入了830例接受硬膜外导管的儿童的数据（胸段/腰段 = 691例；骶管 = 139例）。接受胸段/腰段硬膜外麻醉的青少年（12 - 18岁）与学龄前儿童和学龄儿童相比，疼痛评分更高（P < 0.05），且额外接受的全身性阿片类药物更少（P < 0.001）。在胸段/腰段硬膜外组中，接受脊柱手术的儿童与接受胸部手术的儿童疼痛评分相当，但高于接受腹部或四肢手术的儿童（P < 0.05）。然而，接受脊柱手术的儿童额外使用的阿片类药物较少，但仅在术后第一天有显著差异（P = 0.032）。
该数据库分析表明，年龄较大的儿童以及接受胸部或脊柱手术的儿童报告的疼痛评分显著更高，很可能是因为他们额外接受的阿片类药物较少。因此，更“积极”的疼痛治疗（包括在适当监测下按需使用阿片类药物）可能会进一步改善术后护理。
