Department of Orthopedics, University of North Carolina Hospitals, Chapel Hill, NC.
J Pediatr Orthop. 2020 Nov/Dec;40(10):543-548. doi: 10.1097/BPO.0000000000001639.
The purpose of this 2-part study is to determine opioid prescribing patterns and characterize actual opioid use and postoperative pain control in children following discharge after closed reduction and percutaneous pinning of a supracondylar humerus fracture.
A retrospective study was conducted from 2014 to 2016 to determine pain medication prescribing patterns at a single level 1 trauma center. Next, a prospective, observational study was conducted from 2017 to 2018 to determine actual pain medication use and pain scores in the acute postoperative period. Data were collected through telephone surveys performed on postoperative day 1, 3, and 5. Pain scores were collected using a parental proxy numerical rating scale (0 to 10) and opioid use was recorded as the number of doses taken.
From 2014 to 2016, there were 126 patients who were prescribed a mean of 47 doses of opioid medication at discharge. From 2017 to 2018, telephone questionnaires were completed in 63 patients. There was no significant difference (P>0.05) in pain ratings or opioid use by fracture type (Gartland), age, or sex. Children required a mean of 4 doses of oxycodone postoperatively. There were 18 (28%) patients who did not require any oxycodone. On average, pain scores were highest on postoperative day 1 (average 5/10) and decreased to clinically unimportant levels (<1) by postoperative day 5. Acetaminophen and ibuprofen were utilized as first-line pain medications in only 25% and 9% of patients, respectively. Two of 3 patients who used >15 oxycodone doses experienced a minor postoperative complication.
Pediatric patients have been overprescribed opioids after operative treatment of supracondylar humerus fractures at our institution. Families who report pain scores >5 of 10 and/or persistent opioid use beyond postoperative day 5 warrant further clinical evaluation. Two of 3 pain outliers in this study experienced a minor postoperative complication. With appropriate parental counseling, satisfactory pain control can likely be achieved with acetaminophen and ibuprofen for most patients. If oxycodone is prescribed for breakthrough pain, then the authors recommend limiting to <6 doses.
Level IV-observational, cohort study.
本研究分为两部分，旨在确定儿童肱骨髁上骨折闭合复位经皮穿针术后出院时阿片类药物的开具模式，并描述实际的阿片类药物使用情况和术后疼痛控制情况。
2014 年至 2016 年进行了一项回顾性研究，以确定在单一 1 级创伤中心开具的疼痛药物处方模式。随后，2017 年至 2018 年进行了一项前瞻性、观察性研究，以确定急性术后期间实际的疼痛药物使用情况和疼痛评分。通过术后第 1、3 和 5 天进行的电话调查收集数据。疼痛评分采用父母代表数字评分量表（0 至 10）进行评估，阿片类药物使用量记录为服用的剂量数。
2014 年至 2016 年，共有 126 名患者出院时开具了平均 47 剂阿片类药物，2017 年至 2018 年，有 63 名患者完成了电话问卷调查。按骨折类型（Gartland）、年龄或性别划分，疼痛评分或阿片类药物使用无显著差异（P>0.05）。患儿术后平均需服用 4 剂羟考酮。18 名（28%）患者无需服用任何羟考酮。平均而言，疼痛评分在术后第 1 天最高（平均 5/10），术后第 5 天降至临床无意义水平（<1）。在仅 25%和 9%的患者中，对乙酰氨基酚和布洛芬分别被用作一线止痛药物。在使用>15 剂羟考酮的 3 名患者中，有 2 名出现轻微术后并发症。
在我们机构，肱骨髁上骨折手术后的儿科患者开具了过多的阿片类药物。如果报告疼痛评分>10 分的 5/10 或术后第 5 天仍持续使用阿片类药物的家庭，需要进一步临床评估。本研究中的 3 名疼痛异常患者中有 2 名出现轻微术后并发症。通过适当的父母咨询，大多数患者可能可以通过对乙酰氨基酚和布洛芬获得满意的疼痛控制。如果开具羟考酮治疗突破性疼痛，则建议限制使用<6 剂。
IV 级-观察性队列研究。
