Swanson Christopher E, Chang Kit, Schleyer Edward, Pizzutillo Peter D, Herman Martin J
St. Christopher's Hospital for Children, Philadelphia, PA 19134, USA.
J Pediatr Orthop. 2012 Jul-Aug;32(5):452-5. doi: 10.1097/BPO.0b013e318259f85a.
Postoperative pain control in pediatric patients has become a priority for all institutions. There is a paucity of literature on pain control after orthopedic procedures in the pediatric population. The purpose of this study is to compare the efficacy of acetaminophen with narcotic analgesics, specifically, acetaminophen/codeine and morphine, for pain management after closed reduction and percutaneous pinning of displaced supracondylar humerus fractures in children.
We retrospectively evaluated 217 patients who received closed reduction and percutaneous pinning of type II or III supracondylar humerus fractures at our institution from 2003 to 2009. Hospital charts were reviewed to obtain demographic data. Patients were divided into narcotic and non-narcotic groups. The Oucher and FLACC scales were used to quantify the effectiveness of the pain control that was delivered.
A total of 174 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, whereas the mean postoperative 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 with a mean pain score of 2.4 for the narcotic subgroup. This difference was not statistically significant. Severe nausea or vomiting attributed to either class of medication was not observed. In addition, no patients developed a compartment syndrome.
Acetaminophen is as effective as narcotic analgesics for providing pain control after supracondylar fracture surgery in children and is historically associated with fewer side effects. It is our recommendation to use acetaminophen alone for postoperative pain control in these patients.
III.
小儿患者术后疼痛控制已成为所有医疗机构的首要任务。关于小儿骨科手术后疼痛控制的文献较少。本研究的目的是比较对乙酰氨基酚与麻醉性镇痛药，特别是对乙酰氨基酚/可待因和吗啡，在儿童移位性肱骨髁上骨折闭合复位和经皮穿针固定术后疼痛管理中的疗效。
我们回顾性评估了2003年至2009年在我院接受II型或III型肱骨髁上骨折闭合复位和经皮穿针固定的217例患者。查阅医院病历以获取人口统计学数据。患者分为麻醉组和非麻醉组。使用Oucher量表和面部表情、腿活动、活动、哭闹、安慰量表（FLACC量表）来量化所提供的疼痛控制效果。
共有174例患者接受非麻醉性止痛药治疗，43例患者接受麻醉药治疗。这些患者的平均年龄为5.45岁。非麻醉组术后平均疼痛评分为1.9，而麻醉组术后平均疼痛评分为2.2。这种差异无统计学意义。为了考虑患者年龄差异和骨折类型严重程度，我们创建了一个仅包含III型肱骨髁上骨折的年龄匹配患者队列。该组的平均年龄为6.22岁。对乙酰氨基酚亚组的平均疼痛评分为2.1，而麻醉亚组的平均疼痛评分为2.4。这种差异无统计学意义。未观察到因任何一类药物引起的严重恶心或呕吐。此外，没有患者发生骨筋膜室综合征。
对乙酰氨基酚在小儿肱骨髁上骨折手术后提供疼痛控制方面与麻醉性镇痛药同样有效，并且从历史上看副作用较少。我们建议在这些患者中单独使用对乙酰氨基酚进行术后疼痛控制。
III级。
