Henson Laurence O, Chiem Jennifer, Joseph Emmanuella, Patrao Fiona, Low Daniel King-Wai
From the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Wash.
Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, Wash.
Pediatr Qual Saf. 2025 Jan 7;10(1):e777. doi: 10.1097/pq9.0000000000000777. eCollection 2025 Jan-Feb.
Supracondylar fractures are among the most common injuries in the pediatric population. Recently, there has been increased interest in developing opioid-free anesthetic protocols that achieve these same goals without the risks associated with opioid use, such as postoperative nausea and vomiting (PONV), delayed discharges, and respiratory depression.
Seattle Children's Hospital implemented opioid-free anesthesia (OFA) for pediatric supracondylar fracture repairs in January 2021. This patient safety report compares the clinical outcomes of these patients to those who received intraoperative opioids. Clinical effectiveness was measured using the maximum pain scores in the postanesthesia care unit (PACU), postoperative opioid rescue rates in PACU and PONV rescue rate. PACU length of stay (LOS) was chosen as a clinical balancing measure.
The opioid group (n = 464) had a mean maximum pain score of 3.39 compared with the OFA group (n = 816), which had a mean maximum of 3.70. The PACU IV opioid rescue rate for the opioid group was 38.82%, whereas the OFA group was 38.73%. The opioid group had a PONV rescue rate of 1.53%, compared with 0.23% in the OFA group. Mean LOS in the PACU was 79 minutes for the opioid group and 86 minutes for the OFA group.
The shift to OFA for intraoperative management of patients' supracondylar fracture repair resulted in similar postoperative analgesic outcomes when compared with an opioid-based approach, with a reduced PONV rate and minimal increase in LOS. Transitioning to OFA provided a safe and effective protocol for supracondylar repairs.
髁上骨折是儿科人群中最常见的损伤之一。最近，人们对开发无阿片类麻醉方案的兴趣日益增加，这些方案能在不产生与使用阿片类药物相关风险（如术后恶心呕吐、出院延迟和呼吸抑制）的情况下实现相同目标。
西雅图儿童医院于2021年1月对小儿髁上骨折修复实施了无阿片类麻醉（OFA）。本患者安全报告将这些患者的临床结果与接受术中阿片类药物治疗的患者进行了比较。临床疗效通过麻醉后护理单元（PACU）的最大疼痛评分、PACU术后阿片类药物挽救率和术后恶心呕吐挽救率来衡量。选择PACU住院时间（LOS）作为临床平衡指标。
阿片类药物组（n = 464）的平均最大疼痛评分为3.39，而OFA组（n = 816）的平均最大疼痛评分为3.70。阿片类药物组的PACU静脉注射阿片类药物挽救率为38.82%，而OFA组为38.73%。阿片类药物组的术后恶心呕吐挽救率为1.53%，而OFA组为0.23%。阿片类药物组在PACU的平均住院时间为79分钟，OFA组为86分钟。
与基于阿片类药物的方法相比，在术中对患者髁上骨折修复进行管理时转向OFA可产生相似的术后镇痛效果，术后恶心呕吐发生率降低，住院时间增加最少。向OFA过渡为髁上骨折修复提供了一种安全有效的方案。
