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Randomized comparison of pain perception during radial head subluxation reduction using supination-flexion or forced
Daniel A Green1, Marc Y-R Linares, Barbara M Garcia Peña
1Baylor College of Medicine and Emergency Center, Texas Children's Hospital, Houston, TX, USA.
Insights
Forced pronation is perceived as less painful than supination-flexion for reducing radial head subluxation (RHS) in children. Parents and nurses reported significantly less pain with the forced pronation method.
Area of Science:
- Pediatric Emergency Medicine
- Orthopedic Surgery
- Pain Management
Background:
- Radial head subluxation (RHS) is a common elbow injury in children.
- Current reduction techniques include forced pronation and supination-flexion.
- Pain perception during reduction is a significant concern for patients and families.
Purpose of the Study:
- To compare perceived pain between forced pronation and supination-flexion methods for RHS reduction.
- To evaluate the perspectives of parents, physicians, and nurses on pain during RHS reduction.
Main Methods:
- Prospective randomized trial involving children aged 6 months to 7 years with suspected RHS.
- Children were randomized to either forced pronation or supination-flexion reduction.
- Pain was assessed using a visual analog scale by parents, physicians, and nurses before, during, and after reduction.
Main Results:
- Physicians reported no significant difference in pain perception between the two methods.
- Nurses and parents reported significantly less pain with the forced pronation method (P < 0.031 and P < 0.043, respectively).
- The mean pain difference reported by parents for forced pronation exceeded the clinically significant threshold.
Conclusions:
- Forced pronation is perceived as less painful than supination-flexion by parents and nurses for pediatric radial head subluxation.
- This finding suggests forced pronation may be a preferred method for RHS reduction to minimize patient discomfort.
Objective:
To determine if a difference exists in perceived pain between the forced pronation and supination-flexion methods of radial head subluxation (RHS) reduction.
Design And Methods:
We developed a prospective randomized trial of children aged 6 months to 7 years who presented to the emergency department (ED) at Miami Children's Hospital with an immobile arm and physical findings suggestive of RHS. Children were randomized into 2 groups for RHS reduction: forced pronation and supination-flexion. Parents, physicians, and nurses were given a standard visual analog pain scale for pain assessment before, during, and at 1 minute after successful reduction.
Results:
Seventy-five children presented to the ED with RHS; 3 children were excluded from the study because of nonadherence to the protocol and another 9 were excluded because of unsuccessful reduction during the first attempt. Of the remaining children, 32 children underwent forced pronation and 31 underwent supination-flexion. Physicians did not find a significant difference in gain scores between their perceptions of the premeasure and postmeasure of pain between those patients receiving supination-flexion and those receiving forced pronation. For nurses (P < 0.031) and parents (P < 0.043), there were statistically significant differences in gain scores. Nurses and parents perceived forced pronation as being less painful. The mean difference for parents was 1.7 cm, which exceeded the value of 1.3 cm identified as clinically significant.
Conclusions:
Forced pronation is perceived as less painful than the supination-flexion method by parents of children treated for RHS in our ED.
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