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Postoperative pain control after supracondylar humerus fracture fixation
Christopher E Swanson1, Kit Chang, Edward Schleyer
1St. Christopher's Hospital for Children, Philadelphia, PA 19134, USA.
Insights
Acetaminophen is as effective as narcotic analgesics for pediatric pain control after supracondylar fracture surgery. This study recommends acetaminophen alone due to fewer side effects.
Area of Science:
- Pediatric Orthopedic Surgery
- Pain Management
- Pharmacology
Background:
- Postoperative pain management in children undergoing orthopedic procedures requires further investigation.
- Limited literature exists on effective pain control strategies for pediatric supracondylar humerus fractures.
Purpose of the Study:
- To compare the efficacy of acetaminophen versus narcotic analgesics for pain management in children after closed reduction and percutaneous pinning of displaced supracondylar humerus fractures.
Main Methods:
- Retrospective evaluation of 217 pediatric patients (2003-2009) who underwent closed reduction and percutaneous pinning for supracondylar humerus fractures.
- Patients were categorized into non-narcotic (acetaminophen) and narcotic (acetaminophen/codeine, morphine) groups.
- Pain was quantified using the Oucher and FLACC scales.
Main Results:
- No statistically significant difference in mean postoperative pain scores between the non-narcotic (1.9) and narcotic (2.2) groups.
- An age-matched cohort analysis of type III fractures also showed no significant pain score difference (acetaminophen 2.1 vs. narcotic 2.4).
- No severe nausea, vomiting, or compartment syndrome was observed in either group.
Conclusions:
- Acetaminophen demonstrates comparable efficacy to narcotic analgesics for postoperative pain control in pediatric patients with supracondylar humerus fractures.
- Acetaminophen is associated with fewer side effects compared to narcotics.
- The study recommends utilizing acetaminophen as a primary agent for postoperative pain management in this patient population.
Background:
Postoperative pain control in pediatric patients has become a priority for all institutions. There is a paucity of literature on pain control after orthopedic procedures in the pediatric population. The purpose of this study is to compare the efficacy of acetaminophen with narcotic analgesics, specifically, acetaminophen/codeine and morphine, for pain management after closed reduction and percutaneous pinning of displaced supracondylar humerus fractures in children.
Methods:
We retrospectively evaluated 217 patients who received closed reduction and percutaneous pinning of type II or III supracondylar humerus fractures at our institution from 2003 to 2009. Hospital charts were reviewed to obtain demographic data. Patients were divided into narcotic and non-narcotic groups. The Oucher and FLACC scales were used to quantify the effectiveness of the pain control that was delivered.
Results:
A total of 174 patients were treated with non-narcotic pain medications and 43 patients received narcotics. The average age of these patients was 5.45 years. The mean postoperative pain score for the non-narcotic group was 1.9, whereas the mean postoperative pain score for the narcotic group was 2.2. This difference was not statistically significant. To account for the difference of age in patients and severity of fracture type, we created an age-matched cohort of patients with only type III supracondylar fractures. The average age of this group was 6.22 years. The mean pain score for the acetaminophen subgroup was 2.1 compared with a mean pain score of 2.4 for the narcotic subgroup. This difference was not statistically significant. Severe nausea or vomiting attributed to either class of medication was not observed. In addition, no patients developed a compartment syndrome.
Conclusions:
Acetaminophen is as effective as narcotic analgesics for providing pain control after supracondylar fracture surgery in children and is historically associated with fewer side effects. It is our recommendation to use acetaminophen alone for postoperative pain control in these patients.
Level Of Evidence:
III.
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