Opioid versus Non-Opioid Postoperative Pain Management for Pediatric Supracondylar Humerus Fractures

Opioid misuse is a leading cause of unintentional adolescent injury. Prescribing opioids for postoperative pain management in pediatric supracondylar humerus fracture fixation is controversial. This study compares opioid pain medication versus non-opioid pain medication use in outpatient pain control after such fixation.

This retrospective review involved subjects <18 years old who underwent closed reduction and percutaneous pinning (CRPP) of Gartland type II-IV supracondylar humerus fractures. Two cohorts received differing postoperative pain control: opioid medication and non-opioid medication based on standard of care for the practitioner. Exclusions included patients requiring open reduction, distracting injuries, or complications like compartment syndrome or vascular compromise. Primary outcomes were the number of call-ins for pain and pain rating at the first postoperative visit. Secondary variables included demographics, Gartland classification, return to the emergency department, and complications. Categorical variables were compared between groups using Chi-square tests. Continuous variables were compared between groups using t-tests, if normally distributed, or Wilcoxon Rank Sum tests if not. Between group differences in number of call-ins as well as postop ED and clinic visits were evaluated using Cochran-Armitage trends tests.

The study included 399 participants prescribed opioids and 48 participants prescribed non-opioids. Demographic comparisons showed a near-equal sex distribution (p=0.28). The most common fracture was Gartland type III (opioid cohort: 57.6%, non-opioid cohort: 52%). Most subjects reported no pain at the first postoperative visit (opioid: 93.5%, non-opioid: 95.8%; p=0.75) and did not call-in regarding pain (opioid: 87.5%, non-opioid: 85%; p=0.89). The complication rate was similar between cohorts (opioid: 22.3%, non-opioid: 16.7%; p=0.37). The opioid cohort had a 3.5% early return to the emergency department, while the non-opioid cohort had no early returns (p=0.38).

Displaced supracondylar humerus fractures, a common pediatric orthopedic injury, are typically treated surgically. Opioid medications are often prescribed at hospital discharge. This study demonstrates nearly all patients achieved adequate pain control without opioids. Non-opioid pain medication provided effective pain management at the first postoperative visit, with no increase in emergency department returns or pain-related phone calls. These results suggest non-opioid pain medications can adequately control pain after CRPP of supracondylar humerus fractures. Level of Evidence: III.