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Transitioning to Opioid-free Anesthesia for Pediatric Supracondylar Fracture Repairs: A Patient Safety Report

Laurence O Henson1, Jennifer Chiem1,2, Emmanuella Joseph1

  • 1From the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Wash.

Pediatric Quality & Safety
|January 8, 2025
PubMed

Insights

Opioid-free anesthesia (OFA) for pediatric supracondylar fracture repair shows similar pain control to opioid use. OFA reduced postoperative nausea and vomiting (PONV) and had a minimal impact on recovery time.

Area of Science:

  • Pediatric Anesthesiology
  • Orthopedic Surgery
  • Patient Safety

Background:

  • Supracondylar fractures are common pediatric injuries.
  • Opioid-based anesthesia carries risks like PONV and respiratory depression.
  • Opioid-free anesthesia (OFA) is an emerging alternative.

Purpose of the Study:

  • To compare clinical outcomes of OFA versus opioid-based anesthesia for pediatric supracondylar fracture repair.
  • To evaluate pain scores, opioid rescue rates, PONV rates, and PACU length of stay (LOS).

Main Methods:

  • Retrospective analysis of pediatric patients undergoing supracondylar fracture repair.
  • Comparison between patients receiving OFA and those receiving intraoperative opioids.
  • Outcomes measured: maximum PACU pain scores, PACU opioid rescue rates, PONV rescue rates, and PACU LOS.

Main Results:

  • OFA group (n=816) had a mean max pain score of 3.70 vs. opioid group (n=464) at 3.39.
  • PACU IV opioid rescue rates were similar: 38.73% (OFA) vs. 38.82% (opioid).
  • PONV rescue rate was significantly lower in the OFA group (0.23%) compared to the opioid group (1.53%).
  • Mean PACU LOS was slightly longer in the OFA group (86 minutes) vs. opioid group (79 minutes).

Conclusions:

  • Opioid-free anesthesia provides comparable postoperative pain management to opioid-based anesthesia for pediatric supracondylar fracture repair.
  • OFA significantly reduces the incidence of postoperative nausea and vomiting.
  • Transitioning to OFA is a safe and effective protocol, with a minimal increase in PACU length of stay.
Abstract

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