Cast Art Analgesia: Investigating the Application of Cast Art as a Distraction Strategy to Mitigate Pain Following Supracondylar Humerus Fracture Surgery in Children.

Abstract

Background: Multiple distraction strategies to mitigate pain and distress during and after hospital procedures and surgery have become widely accepted and used in multimodal pain management in children. One such mode of nonpharmacological intervention and distraction is the application of cast art. There is a paucity of literature investigating the effect that cast art may have on a child's perception of pain. The purpose of this study was to investigate pain reporting and management trends in children undergoing supracondylar humerus fracture (SCHFx) surgery and immobilized postoperatively in a cast with applied custom illustrated cartoon art compared with a plain cast/no-art group.

Methods: Children who underwent closed reduction with percutaneous pinning (CRPP) of SCHFx were identified through retrospective chart review. Children were divided into 2 cohorts: those who received cast art and those who did not. Postoperative Visual Analog Scale (VAS), Face, Legs, Activity, Cry, Consolability scale (FLACC), and pain medication administration were recorded. Data were compared using χ2, ANOVA, and Man-Whitney U tests to determine significance set as P<0.05.

Results: Demographics and fracture type based on the Gartland fracture classification were similar between groups. The cast art group had significantly lower VAS (P=0.009) and FLACC (P=0.004) scores, required less acetaminophen (P=0.048), ibuprofen (P=0.014), and 4 times less children requiring postoperative narcotics (P=0.003) compared with the no art group. The average (+/- SD) surgery time differed between the art and no art groups (24.6+/-8.4 min vs. 20.1+/-5.6 min, P=0.012). Similarly, the average (+/- SD) anesthesia time differed between the art and no art groups (59.9+/-19.4 min vs. 49.9+/-9.9 min, P=0.01).

Conclusion: Children undergoing CRPP for SCHFx fracture were found to have lower pain scores (VAS and FLACC) on the medical-surgical floor postoperatively and had decreased floor analgesic requirements lending evidence that cast art may be an adjunctive distraction strategy to mitigate pain and distress following SCHFx surgery in children.

Level of evidence: Level III-retrospective comparative study.