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Topic:

Supracondylar Humerus Fracture

Issue:

Elbow

Category:

Trauma

Title:

Postoperative Pain and Opioid Use in Children with Supracondylar Humeral Fractures: Balancing Analgesia and Opioid Stewardship

Author:

Nelson SE, Adams AJ, Buczek MJ, Anthony CA, Shah AS

Journal:

J Bone Joint Surg Am

Date:

January 16, 2019

Reference:

101(2):119-126. doi: 10.2106/JBJS.18.00657. PMID: 30653041.

Level Of Evidence:

IV

# of Patients:

81

Study Type:

Prospective

Location:

Children's Hospital of Philadelphia

Summary:

Methods:

81 children with supracondylar humerus fractures, mean age 6.1 SD ±2.1 years, 53.1% with Gartland Type II fractures and 46.9% with Type III. Pain evaluated by Wong-Baker FACES Pain Rating Scale. >90% response rate to

Exclusions:

Exclusion criteria for enrollment: non-English speakers, families without mobile phone, patients with chronic pain, chronic opioid use, metabolic or genetic bone disease, open fractures, vascular injuries, regional anesthesia, cognitive disability

Results:

Pain ratings decreased from mean 3.5 ±3.5 in ER and 3.5±2.4 morning of postop day 1 to <2 (1.8±1.8) by morning of postop day 3. Opioid use was 1-7 doses, patients used only 24.1% of prescribed opioids. No difference in pain ratings or opioid use based on fracture type, age, or gender.

Conclusions:

Authors recommend that only 7 doses of opioid pain medication should be prescribed post-discharge . Reported pain ≥6 post discharge is unusual and should be evaluated for compartment syndrome or ischemia.

Relevance:

Limitations:

Perspective:

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