Opioid Use in Pediatric Supracondylar Humeral Fractures

A recent study published in The Journal of Bone and Joint Surgery found that opioids may not be necessary for treating pediatric supracondylar humeral fractures, challenging the prevailing opioid-prescribing practices in the US.

The study, conducted at multiple medical centers, enrolled children aged 3 to 12 who were undergoing closed reduction and percutaneous pinning (CRPP) for these fractures. Half of the children received a prescription for oxycodone, along with ibuprofen and acetaminophen, while the other half received ibuprofen and acetaminophen alone, thus forming the opioid and non-opioid cohorts, respectively.

Over the course of the study, researchers closely monitored the children's medication use and daily pain levels. Surprisingly, the results showed that there were no significant differences in pain ratings between the two groups at any point during the recovery process. This is a significant finding, indicating that non-opioid analgesia can be just as effective as opioid-based pain relief for pediatric supracondylar humeral fractures.

Moreover, the study revealed that a substantial portion of children in the opioid group did not require oxycodone at all, and opioid use dropped significantly after postoperative day 2. In contrast, only one patient in the non-opioid group required a rescue prescription of opioids, highlighting the minimal need for these powerful painkillers in this context.

This research has far-reaching implications for the healthcare industry, specifically in the context of opioid stewardship. It suggests that providers and institutions should reconsider the routine prescription of opioids following CRPP for pediatric supracondylar humeral fractures. The findings could potentially contribute to the broader effort to reduce opioid dependence and addiction, particularly in the vulnerable population of children.

In an era where opioid misuse and addiction have reached epidemic proportions, this study offers a promising alternative for pain management in pediatric orthopedic procedures. It provides hope that by eliminating the unnecessary prescription of opioids, healthcare professionals can take a significant step toward combating the opioid crisis, starting with the youngest patients.

Source

Belardo, Z. E., Talwar, D., Blumberg, T. J., Nelson, S. E., Upasani, V. V., Sankar, W. N., & Shah, A. S. (2021). Opioid analgesia compared with non-opioid analgesia after operative treatment for pediatric supracondylar humeral fractures: Results from a prospective multicenter trial. The Journal of Bone and Joint Surgery. American Volume, 10.2106/JBJS.23.00223. https://doi.org/10.2106/JBJS.23.00223