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Updated: Jun 10, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
Opioid-free Postoperative Pain Management in Pediatric Upper Limb Fracture Surgery: A Prospective Observational Study
Karthik Subrahmanya1, Vishwas Kadambila2, Shravya Shrinivas Rao3
1Department of Orthopaedics, Siddaganga Medical College and Research Institute, Tumkur, Karnataka, India.
Insights
An opioid-free pain management protocol using acetaminophen effectively controlled postoperative pain in children with upper limb fractures. This approach reduced the need for additional analgesics and proved safe for pediatric orthopedic trauma patients.
Area of Science:
- Pediatric Orthopedics
- Pain Management
- Pharmacology
Background:
- Postoperative pain in pediatric fracture surgery presents challenges, with opioids causing adverse effects.
- Opioid stewardship drives interest in opioid-free strategies for pediatric orthopedic trauma, but real-world data are limited.
Purpose of the Study:
- To evaluate postoperative pain outcomes and analgesic needs in children undergoing upper limb fracture surgery with a standardized opioid-free protocol.
Main Methods:
- Prospective observational study of 50 children (5-18 years) undergoing upper limb fracture surgery.
- Standardized protocol: scheduled acetaminophen, with ibuprofen as rescue analgesia.
- Pain intensity assessed via Numerical Rating Scale (NRS) on postoperative days 1-3.
Main Results:
- Mean NRS scores significantly decreased from POD 1 (4.02) to POD 3 (1.64).
- Only 12% of patients required rescue ibuprofen; no patients required opioids.
- No analgesic-related adverse events were observed.
Conclusions:
- An acetaminophen-centered, opioid-free protocol effectively managed pain after pediatric upper limb fracture surgery.
- This approach significantly reduced the need for additional analgesia.
- Findings support the feasibility and safety of opioid-free management in pediatric orthopedic trauma.
Background:
Postoperative pain management in pediatric fracture surgery is challenging. Opioid analgesics, conventionally used for moderate-to-severe pain, are associated with significant adverse effects in children, including respiratory depression, nausea, and sedation. Growing emphasis on opioid stewardship has increased interest in opioid-free strategies; however, real-world data in pediatric orthopedic trauma remain limited.
Objectives:
The objective is to evaluate postoperative pain outcomes and analgesic requirements in children undergoing upper limb fracture surgery managed with a standardized opioid-free protocol.
Methods:
This prospective observational study included children aged 5-18 years who underwent closed reduction and internal fixation of upper limb fractures between January and December 2025. All patients received scheduled postoperative acetaminophen. Ibuprofen was permitted only as rescue analgesia for persistent moderate pain. Pain intensity was assessed using the Numerical Rating Scale (NRS) on postoperative days (POD) 1, 2, and 3. Analgesic requirements, hospital stay, and adverse events were recorded.
Results:
Fifty patients were included (30 males, 20 females; mean age 11.2 ± 2.8 years). Mean NRS scores decreased significantly from POD 1 (4.02 ± 0.96) to POD 2 (2.78 ± 0.88) and POD 3 (1.64 ± 0.82) (P < 0.001). Rescue ibuprofen was required in six patients (12%). No patient required opioids, and no analgesic-related adverse events were observed.
Conclusion:
An acetaminophen-centered, opioid-free protocol provided effective pain control following pediatric upper limb fracture surgery and markedly reduced the need for additional analgesia. These findings support the feasibility and safety of opioid-free management in pediatric orthopedic trauma.
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