Post-operative Pain Control in Supracondylar Humerus Fracture Fixation

INTRODUCTION: Post-operative pain control in pediatric patients has become a priority for all institutions. There is a paucity of literature on pain control following orthopedic procedures in the pediatric population. The purpose of this study is to compare the efficacy of acetaminophen to narcotic analgesics, specifically, acetaminophen/codeine and morphine, for pain management after closed reduction and percutaneous pinning (CRPP) of displaced supracondylar humerus fractures in children. METHODS: We retrospectively evaluated 217 patients who received CRPP of Gartland Type II or III supracondylar humerus fractures at our institution from 2003-2009. Hospital charts were reviewed to obtain demographic data. Patients were divided into a narcotic and non-narcotic group. The Oucher and FLACC scales were used to quantify the effectiveness of the pain control that was delivered. Statistical significance was obtained using un-paired T-tests. In addition, complications as well as time to discharge were recorded for all patients. RESULTS: One hundred seventy-four patients were treated with non-narcotic pain medications and 43 patients received narcotics. The average age of these patients was 5.45 years. The mean postoperative pain score for the non-narcotic group was 1.9, while the mean post-operative pain score for the narcotic group was 2.2. This difference was not statistically significant. To account for the difference of age in patients and severity of fracture type we created an age matched cohort of patients with only Type III supracondylar fractures. The average age of this group was 6.22 years. The mean pain score for the acetaminophen subgroup was 2.1 compared to a mean pain score of 2.4 for the narcotic subgroup. This difference was not statistically significance. Severe nausea or vomiting attributed to either class of medication was not observed. In addition no patients developed a compartment syndrome. DISCUSSION AND CONCLUSION: Acetaminophen is as effective as narcotic analgesics for providing pain control after supracondylar fracture surgery in children, and are generally associated with fewer side effects. It is our recommendation to use acetaminophen alone for post-operative pain control in these patients.