Improving Postoperative Pain Management in Pediatric Supracondylar Humerus Fractures With Local Anesthesia.

Background: With an annual incidence of 177 per 100,000 patients, supracondylar humerus fractures (SCHF) are the most common elbow fracture in the pediatric population.1,2 Pain control after closed reduction and percutaneous pinning (CRPP) of SCHF may be improved with the use of a local anesthetic. We aimed to assess the effects of local bupivacaine administration on immediate post-operative pain and opioid requirements.

Methods: A retrospective chart review was performed for patients undergoing CRPP of SCHF from September 1, 2018 to September 30, 2022 at a single institution. Two groups (local vs. no local) were formed based on intraoperative administration of bupivacaine. Post-anesthesia care unit (PACU) records were reviewed for type and dose of pain medications administered and pain scores.

Results: Three hundred thirty-five patients (114 local, 221 no local) were included in review. No differences were noted in demographic or injury characteristics. The local and no-local groups had average PACU pain scores of 2.2±3.2 and 3.3±3.5, respectively. There was no significant difference between groups in percentage of patients who received Tylenol, Motrin, and Toradol. There was a significant difference in the number of patients who received morphine with 42% of patients in the local group requiring morphine compared with 64% of patients in the no-local group. The average weight-based dose of morphine in the local group was 0.002 mg/kg±0.001 and 0.003 mg/kg±0.008 in the no-local group. No differences were noted in postoperative complications or unexpected follow-up.

Conclusions: The use of local bupivacaine intraoperatively improved pain control as evidenced by fewer patients requiring morphine and lower pain scores in the local group. Local bupivacaine is a low-cost, low-risk intervention that can be used after CRPP of SCHF that may improve immediate postoperative pain and facilitate quicker transition to oral pain medications with decreased need for IV opioid medications.

Level of evidence: Level IIIB-retrospective comparative study.