The efficacy of intra-articular injections for pain control following the closed reduction and percutaneous pinning of pediatric supracondylar humeral fractures: a randomized controlled trial.

Abstract

BACKGROUND:

The purpose of this single-blinded, randomized, controlled trial was to compare the analgesic efficacy of intra-articular injections of bupivacaine or ropivacaine with that of no injection for postoperative pain control after the operative treatment of supracondylar humeral fractures in a pediatric population.

METHODS:

Subjects (n=124) were randomized to treatment with 0.25% bupivacaine (Group B) (n=42), 0.20% ropivacaine (Group R) (n=39), or no injection (Group C) (n=43). The opioid doses and the times of administration as well as child-reported pain severity (Faces Pain Scale-Revised) and parent-reported pain severity (Total Quality Pain Management survey) were recorded.

RESULTS:

The proportion of subjects who required morphine and/or fentanyl injections was significantly (p=0.004) lower in Group B (10%) as compared with Group R (36%) and Group C (44%). On the basis of the log-rank test, the opioid-free survival rates were significantly greater in Group B as compared to Groups C and R. Total opioid consumption (morphine equivalent mg/kg) in the first seventy-two hours postoperatively was significantly less in Group B as compared with Group C (mean difference, 0.225; [95% confidence interval (CI), 0.0152 to 0.435]; p=0.036). Parent-reported pain scores were also significantly lower in Group B as compared with both Group C (mean difference, 1.81 [95% CI, 0.38 to 3.25]; p=0.014) and Group R (mean difference, 1.66; 95% CI, 0.20 to 3.12; p=0.027). There were no significant differences across the three groups in terms of self-reported pain. Differences between Groups R and C were not significant for any of the outcome variables.

CONCLUSIONS:

The intra-articular injection of 0.25% bupivacaine significantly improves postoperative pain control following the closed reduction and percutaneous pinning of supracondylar humeral fractures in pediatric patients.

• Authors: Gaia Georgopoulos, Patrick Carry, Zhaoxing Pan, Frank Chang, Travis Heare, Jason Rhodes, Mark Hotchkiss, Nancy H Miller, Mark Erickson
• Journal: The Journal of bone and joint surgery. American volume (J Bone Joint Surg Am) Vol. 94 Issue 18 Pg. 1633-42 (Sep 19 2012) ISSN: 1535-1386 [Electronic] United States
• PMID: 22878686 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural)

Chemical References

• Amides
• Anesthetics, Local
• Ropivacaine
• Bupivacaine

Topics

• Amides (therapeutic use)
• Analysis of Variance
• Anesthetics, Local (therapeutic use)
• Bone Nails
• Bupivacaine (therapeutic use)
• Chi-Square Distribution
• Child
• Child, Preschool
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Female
• Follow-Up Studies
• Fracture Fixation (instrumentation, methods)
• Hospitals, Pediatric
• Humans
• Humeral Fractures (diagnostic imaging, surgery)
• Injections, Intra-Articular
• Injury Severity Score
• Intra-Articular Fractures (diagnostic imaging, surgery)
• Kaplan-Meier Estimate
• Male
• Pain Measurement (drug effects)
• Pain, Postoperative (diagnosis, drug therapy)
• Radiography
• Risk Assessment
• Ropivacaine
• Single-Blind Method
• Treatment Outcome
• Elbow Injuries