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

• Published in: Journal of bone and joint surgery. American volume Vol. 94; no. 18; p. 1633
• Main Authors: Georgopoulos, Gaia, Carry, Patrick, Pan, Zhaoxing, Chang, Frank, Heare, Travis, Rhodes, Jason, Hotchkiss, Mark, Miller, Nancy H, Erickson, Mark
• Format: Journal Article
• Language: English
• Published: United States 19.09.2012
• Subjects: 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; Elbow Joint - injuries; Female; Follow-Up Studies; Fracture Fixation - instrumentation; Fracture Fixation - methods; Hospitals, Pediatric; Humans; Humeral Fractures - diagnostic imaging; Humeral Fractures - surgery; Injections, Intra-Articular; Injury Severity Score; Intra-Articular Fractures - diagnostic imaging; Intra-Articular Fractures - surgery; Kaplan-Meier Estimate; Male; Pain Measurement - drug effects; Pain, Postoperative - diagnosis; Pain, Postoperative - drug therapy; Radiography; Risk Assessment; Single-Blind Method; Treatment Outcome
• ISSN: 1535-1386
• DOI: 10.2106/JBJS.K.01173

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. 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. 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. 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.