European journal of anaesthesiology
July 17, 2026 · via Europe PMC
Age-related patterns in postoperative pain: insights from the paediatric pain out registry: A prospective cohort study.
Simonte R, Zaslansky R, Oppitz F, +6 more, Rijsdijk M
AI summary — for doctors, generated from the abstract only
79% of children had moderate to severe pain after surgery, with pain rising with age and peaking around 12 years, especially in girls.
What was studied
A prospective cohort of 2005 children aged 4 to 18 from the paediatric PAIN OUT registry (Germany, Netherlands, Austria) after common surgeries, analysing worst pain on day 1 by age and sex.
Key findings
- 79% experienced moderate to severe pain
- Age-related increase in pain intensity in girls (interaction coefficient 0.08)
- Appendectomy and no regional anaesthesia associated with higher pain
- Older children received higher opioid doses for some procedures
Clinical relevance
Highlights undertreated paediatric postoperative pain and potential age- and sex-specific needs.
Who should care
Limitations
Registry data from selected hospitals; residual confounding possible.
Most children hurt a lot after surgery, particularly girls around puberty.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
BACKGROUND
Postoperative pain is common in children, yet its relationship to age and sex remains underexplored.
OBJECTIVES
We hypothesise that postoperative pain intensity varies across age groups. The objective is to identify ages at which high pain with functional impairment is most prevalent and assess any sex difference in the association between age and postoperative pain.
DESIGN
Cohort study.
SETTING
Data were extracted from the paediatric PAIN OUT registry, an international registry. Data were prospectively collected at hospitals in Germany, the Netherlands and Austria.
PATIENTS
The study includes 2005 patients aged 4 to 18 years who underwent appendectomy, tonsillectomy, hernia repair, orthopaedic, or spinal fusion surgery.
MAIN OUTCOME MEASURES
Postsurgical pain scores (Faces Pain Scale 0 to 10) were compared between surgical procedures, stratified by sex, and age. The association between the primary outcome, 'worst pain' score on the first day after surgery, and age and sex was analysed using regression models adjusted for confounding factors: surgery type, duration, perioperative opioid consumption, and use of regional anaesthesia.
RESULTS
Postoperative pain intensity was high with 79% of children experiencing moderate to severe pain, increasing with age, peaking around 12 years, particularly in girls. The regression model confirmed an age-related increase in pain intensity in females (interaction coefficient: 0.08, 95% confidence interval 0.02 to 0.15, P = 0.017). Appendectomy and not receiving regional anaesthesia were associated with higher pain intensity. Higher mean oral morphine equivalent doses were given to patients aged 12 years or older for appendectomy (0.57 ± 0.52 vs. 0.60 ± 0.66 mg kg -1 , P = 0.003) and spine surgery (2.1 ± 1.6 vs. 2.7 ± 2.4 mg kg -1 , P = 0.038), with comparable doses between the sexes.
CONCLUSIONS
In this paediatric cohort, 79% experienced moderate to severe postoperative pain, with higher scores in children aged 12+ and a peak in girls around the onset of puberty. These findings emphasise the need for improved paediatric pain management with consideration for age and sex-related differences.
DOI
10.1097/EJA.0000000000002459
PMID
42473731
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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