Nonopioid vs. opioid analgesia may be equally effective for pediatric humeral fractures
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Key takeaways:
- Patients who had nonopioid analgesia showed similar pain scores compared with those who had opioid analgesia after pediatric humeral fracture.
- Overall, 75.7% of prescribed opioids went unused.
Published results showed pediatric patients who had closed reduction and percutaneous pinning of a supracondylar humeral fracture and a nonopioid analgesia protocol showed similar pain scores compared with those who had opioid analgesia.
Researchers at Children’s Hospital of Philadelphia performed a multicenter, comparative study to analyze postoperative pain scores from 157 pediatric patients (median age of 6.2 years) who underwent closed reduction and percutaneous pinning of a supracondylar humeral fracture.
According to the study, 81 patients received a standard opioid protocol of oxycodone, ibuprofen and acetaminophen, while 76 patients received a nonopioid protocol of ibuprofen and acetaminophen alone. Outcome measures included medication usage and Wong-Baker FACES Scale pain scores, recorded via text message on postoperative days 1 to 7, 10, 14 and 21.
Overall, researchers found low pain scores for both the opioid cohort and the nonopioid cohort, with similar improvements in pain scores from postoperative day 1 to postoperative day 21. Pain scores decreased from 3.6 at postoperative day 1 to 0.2 at postoperative day 21 among patients in the opioid cohort, while pains scores decreased from 3.3 at postoperative day 1 to 0.2 at postoperative day 21 among patients in the nonopioid cohort.
According to the study, 75.7% of prescribed opioids were unused. Researchers noted 28 patients in the opioid cohort (34.6%) took no oxycodone, and 40 patients (49.4%) took one to three total doses across the postoperative period. They also noted patients rarely took opioids after postoperative day 2. One patient in the nonopioid cohort received rescue opioids after presenting to the ED with cast discomfort.
“To improve opioid stewardship, providers and institutions can consider discontinuing the routine prescription of opioids following this procedure,” the researchers wrote in the study.
Perspective
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The article by Zoe E. Belardo, BA, and colleagues comparing opioid analgesia with nonopioid analgesia after operative treatment of pediatric supracondylar fractures addresses a topic of great importance in pediatric orthopedics. The study's findings shed light on the optimal approach to postoperative pain control in young patients and adds to the growing body of evidence that nonopioid alternatives can effectively manage postoperative pain in children. The study underscores that nonopioid alternatives, such as NSAIDs, and local anesthetics can provide effective pain relief without the potential risks and side effects associated with opioids. This finding aligns with the growing recognition in health care of the need to reduce opioid prescribing, especially in pediatric populations.
Furthermore, the article emphasizes the importance of considering the unique needs and vulnerabilities of pediatric patients. Children are more susceptible to the adverse effects of opioids, and their long-term well-being must be safeguarded. The research from Belardo and colleagues underscores the ethical responsibility of health care providers to prioritize safer pain management options in this demographic. The study's conclusions support evidence-based medicine by advocating for a multimodal approach to pain control in pediatric supracondylar fracture patients. This approach, combining nonopioid medications and techniques, not only effectively manages pain but also reduces the risk of opioid dependence and its associated societal burdens. By highlighting the effectiveness of nonopioid analgesia and advocating for a shift away from opioids, it serves as a valuable resource for clinicians seeking to improve the outcomes and well-being of young patients undergoing operative treatment for supracondylar fractures.
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