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Updated: May 1, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Percutaneous pin removal in the outpatient clinic--do children require analgesia?: a randomized controlled trial
Kevin Boon Leong Lim1, Sara Shuhui Tan2, Sharifah Nazrah Syed Abdullah1
1Department of Orthopaedic Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899. E-mail address for K.B.L. Lim: kevin.lim.BL@kkh.com.sg.
Insights
Oral acetaminophen or ibuprofen did not significantly reduce pain during percutaneous pin removal in children compared to placebo. Pain scores and heart rates returned to baseline levels within ten minutes post-procedure.
Area of Science:
- Pediatric Orthopedics
- Pain Management
- Clinical Trials
Background:
- Percutaneous pins are commonly removed from pediatric fracture patients without analgesia.
- Pin removal can cause significant anxiety for children and caregivers.
- The need for analgesia during pin removal is not well-established.
Purpose of the Study:
- To evaluate the efficacy of oral acetaminophen or ibuprofen in reducing pain during percutaneous pin removal in children.
- To compare the pain experienced with acetaminophen, ibuprofen, and placebo.
Main Methods:
- A randomized controlled trial involving 240 children (ages 5-12) with percutaneous pins in the elbow.
- Participants received acetaminophen, ibuprofen, or vitamin C (placebo) one hour before pin removal.
- Pain scores and heart rate were measured before, immediately after, and ten minutes post-removal.
Main Results:
- No statistically significant or clinically relevant differences in pain scores or heart rate were observed among the acetaminophen, ibuprofen, and placebo groups.
- Confidence intervals excluded clinically relevant differences between treatment groups.
- Pain and heart rate returned to baseline levels within ten minutes after pin removal for all groups.
Conclusions:
- Neither acetaminophen nor ibuprofen provided significant pain relief compared to placebo for percutaneous pin removal in children.
- Oral analgesics were found to be clinically equivalent to placebo.
- Non-narcotic analgesia does not appear to significantly reduce pain or heart rate associated with this procedure.
Background:
Percutaneous pins used in the surgical fixation of fractures in children are often removed in the outpatient clinic without the administration of analgesia. Pin removal can be a cause of anxiety for children, parents, and caregivers. Relatively little is known about the requirement of analgesia for this procedure. In a randomized controlled trial, we evaluated whether oral acetaminophen or ibuprofen reduced the pain experienced during pin removal.
Methods:
Participating in the study were 240 children between the ages of five and twelve years who had two or three percutaneous pins in the elbow following treatment of a supracondylar humeral fracture or a lateral humeral condyle fracture with closed reduction and percutaneous pinning. The patients were randomized into one of three groups (n = 80) allocated to receive acetaminophen, ibuprofen, or vitamin C (placebo) an hour before pin removal. A pain score was obtained and heart rate measured before pin removal, immediately following the procedure, and ten minutes after pin removal.
Results:
No significant differences were found among the study groups in terms of the demographic data of sex, age, side of injury, or number of pins. Pain score and heart rate did not exhibit differences that were either statistically significant or clinically relevant. The change from baseline did not differ significantly among the groups for either measure at either of the follow-up times post pin removal. Immediately after pin removal, the mean difference in pain score (and 95% confidence interval [CI]) between the acetaminophen group and the ibuprofen group was 0.10 (-1.03 to 1.23); between the acetaminophen group and the placebo group, 0.35 (-0.78 to 1.48); and between the ibuprofen group and the placebo group, 0.25 (-0.88 to 1.38). The CIs excluded a clinically relevant difference. Pain scores and heart rates returned to preprocedural baseline levels within ten minutes following pin removal.
Conclusions:
Neither acetaminophen nor ibuprofen significantly reduced the pain score or heart rate associated with percutaneous pin removal in children as compared with the placebo. The oral analgesics administered were clinically equivalent to the placebo. These results suggest that non-narcotic analgesia use does not significantly reduce pain or heart rate associated with percutaneous pin removal in children.
