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Local Hematoma Block as Postoperative Analgesia in Pediatric Supracondylar Humerus Fractures
Eric Astacio1, Gabriel Echegaray1, Lenny Rivera1
1Orthopedic Department, University of Puerto Rico Medical Sciences Campus, San Juan, PR.
Insights
Local hematoma blocks did not improve pain control or reduce opioid use in pediatric supracondylar humerus fractures. This study suggests exploring novel, opioid-free pain management strategies for these common pediatric fractures.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Pain Management
Background:
- Supracondylar humerus fracture (SHF) is the most common fracture in children.
- Effective postoperative pain management is crucial for pediatric patients undergoing surgical fixation.
Purpose of the Study:
- To evaluate the efficacy of local hematoma block with 0.25% bupivacaine for postoperative pain control in pediatric SHF.
- To assess its impact on opioid consumption and pain scores after closed reduction pin fixation.
Main Methods:
- Prospective cohort study of 65 pediatric patients with SHF.
- Randomized into a treatment group (hematoma block) and a control group (no block).
- Evaluated postoperative morphine equivalent consumption and Faces Pain Scale-Revised (FPS-R) scores on postoperative day 1.
Main Results:
- No significant difference in morphine equivalent consumption between the hematoma block and control groups.
- Similar FPS-R survey results were observed in both groups.
- No complications associated with the hematoma block were reported.
Conclusions:
- Local hematoma block with bupivacaine did not demonstrate improved pain control or reduced opioid requirements in pediatric SHF.
- Findings suggest the need for further research into alternative, opioid-free pain management strategies for pediatric SHF.
- This study provides a foundation for future investigations into novel pain relief methods.
Purpose:
Supracondylar humerus fracture (SHF) is the most common type of fracture in children. The aim of this study was to evaluate the efficacy of local hematoma block with 0.25% bupivacaine as postoperative pain control in patients with pediatric SHF who underwent closed reduction pin fixation.
Methods:
We performed an institutional review board-approved, prospective cohort study of 65 patients with SHF treated with closed reduction percutaneous pin fixation. For 6 months, all patients were randomly divided into 2 groups. The treatment group (35 patients) received an intraoperative local hematoma block using 0.25% bupivacaine whereas the control group (30 patients) did not receive a local hematoma block as postoperative pain management adjuvant. After surgery, all patients were prescribed opioid pain medication. To evaluate the efficacy of the hematoma block, postoperative morphine equivalent consumption and the Faces Pain Scale-Revised (FPS-R) survey were blindly recorded during postoperative day 1. Demographic data, surgical details, clinical neurovascular examination during the hospital stay, and complications were also evaluated.
Results:
Comparison of the control group with the treatment group showed similar morphine equivalent consumption and Face Pain Scale-Revised Survey results. No hematoma block-associated complications were reported.
Conclusions:
The result of this study do not favor the use of local hematoma block to improve pain control and decrease the need for opioid use on postoperative day 1 in pediatric SHF after patients undergo closed reduction percutaneous pin fixation. These results can lay the foundation for future studies while suggesting new, novel opioid-free pain control strategies in patients with SHF.
Type Of Study/Level Of Evidence:
Therapeutic II.
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