Pain Control and Medication Use in Children Following Closed Reduction and Percutaneous Pinning of Supracondylar Humerus Fractures: Are We Still Overprescribing Opioids?

Abstract

Background: The purpose of this 2-part study is to determine opioid prescribing patterns and characterize actual opioid use and postoperative pain control in children following discharge after closed reduction and percutaneous pinning of a supracondylar humerus fracture. Methods: A retrospective study was conducted from 2014 to 2016 to determine pain medication prescribing patterns at a single level 1 trauma center. Next, a prospective, observational study was conducted from 2017 to 2018 to determine actual pain medication use and pain scores in the acute postoperative period. Data were collected through telephone surveys performed on postoperative day 1, 3, and 5. Pain scores were collected using a parental proxy numerical rating scale (0 to 10) and opioid use was recorded as the number of doses taken. Results: From 2014 to 2016, there were 126 patients who were prescribed a mean of 47 doses of opioid medication at discharge. From 2017 to 2018, telephone questionnaires were completed in 63 patients. There was no significant difference (P>0.05) in pain ratings or opioid use by fracture type (Gartland), age, or sex. Children required a mean of 4 doses of oxycodone postoperatively. There were 18 (28%) patients who did not require any oxycodone. On average, pain scores were highest on postoperative day 1 (average 5/10) and decreased to clinically unimportant levels (<1) by postoperative day 5. Acetaminophen and ibuprofen were utilized as first-line pain medications in only 25% and 9% of patients, respectively. Two of 3 patients who used >15 oxycodone doses experienced a minor postoperative complication. Conclusions: Pediatric patients have been overprescribed opioids after operative treatment of supracondylar humerus fractures at our institution. Families who report pain scores >5 of 10 and/or persistent opioid use beyond postoperative day 5 warrant further clinical evaluation. Two of 3 pain outliers in this study experienced a minor postoperative complication. With appropriate parental counseling, satisfactory pain control can likely be achieved with acetaminophen and ibuprofen for most patients. If oxycodone is prescribed for breakthrough pain, then the authors recommend limiting to <6 doses. Level of Evidence: Level IV—observational, cohort study.

[Retracted] Application Value of Elbow Pressing Method Combined with Zhongtong Ling Application in Children with Swelling and Pain after Operation of Supracondylar Fracture of the Humerus

“…After the fracture, the limbs were injured, thereby causing damage to the meridians, and the blood flow was not smooth, resulting in swelling of the wound. According to the Golden Book of medical science, the circulation of blood and Qi in the human body was slightly stagnant [ 13 ]. Acupoint massage had the functions of dredging meridians, activating blood circulation and removing blood stasis, and supplementing Qi and detumescence.…”

Variation in Prescribing Patterns and Use of Opioids in Pediatric Orthopaedic Surgery Patients

“…Furthermore, hydrocodone is the highest single cause of opioid exposure as reported by the National Poison Data System. 12 On the other hand, oxycodone was chosen for 120/126 pediatric patients with supracondylar humerus fracture at a single Level 1 trauma center in a study by Stillwagon et al 13 A report by Monitto et al also found oxycodone to be prescribed most frequently to pediatric surgery patients. 14 These discrepancies demonstrate probable institution-specific prescribing patterns that are necessary to recognize when considering institutional policy changes around opioid medications.…”

“Double X” Cross Fixationin Paediatric Supracondylar Humerus Fractures: A 20-Year Expertise and 94 Surgical Interventions

“…With proper parental counselling, satisfactory pain control may be achieved with acetaminophen and ibuprofen for most patients. If oxycodone is prescribed for severe pain, the authors recommend its limitation to less than 6 doses [65].…”