Surgeons find over-the-counter medications control pain after elbow surgery as effectively as opioids

Kids who take solely ibuprofen or acetaminophen after routine elbow surgical procedure report comparable ache management to sufferers who take opioids, in keeping with a brand new examine by researchers at Kids’s Hospital of Philadelphia (CHOP). The examine, published within the Journal of Bone and Joint Surgical procedure, suggests surgeons can confidently suggest over-the-counter drugs to sufferers after elbow and discontinue the routine prescription of opioids.

“Ache is a crucial indicator of post-surgical restoration, and we wish to be certain that children should not struggling needlessly, however we additionally wish to be certain that we’re controlling ache in a accountable approach,” stated senior writer Apurva S. Shah, MD, MBA, an attending orthopaedic surgeon at CHOP. “This examine supplies assist for recommending acetaminophen and ibuprofen to patients after elbow fracture surgical procedure, which can enhance opioid stewardship for this widespread surgical procedure and probably for others prefer it.”

Supracondylar humerus (SCH) fractures are the commonest elbow fracture in youngsters and are repaired by a process referred to as closed discount and percutaneous pinning (CRPP), which permits surgeons to restore the fracture with out an incision. A number of research have questioned the necessity for opioids following this process, together with a examine by CHOP researchers that discovered sufferers used lower than 25% of the opioids they had been prescribed, elevating a possible danger of opioid misuse, diversion into communities, and unintended poisonings.

Selling opioid stewardship with out compromising affected person consolation is essential to making sure secure, quality care, however previous to this examine, there was little data on the efficacy of opioid versus non-opioid ache management in sufferers receiving orthopaedic procedures like CRPP.

To assist develop evidence-based pointers for this inhabitants, the researchers enrolled 157 youngsters from 4 tertiary hospitals in the US between Might 2021 and August 2022. The youngsters, who had been between the ages of three and 12, all had SCH fractures that had been being repaired through CRPP.

Roughly half (52%) of the sufferers enrolled within the examine had been prescribed the opioid oxycodone, in addition to ibuprofen and acetaminophen, whereas the opposite half (48%) had been prescribed solely ibuprofen and acetaminophen. Utilizing textual content messages, members reported on the youngsters’s treatment use and day by day ache utilizing the Ache FACES Scale for per week after the surgical procedure, in addition to on days 10, 14 and 21.

The researchers discovered no vital variations in ache scores between opioid and non-opioid teams at any timepoint. Notably, 35% of sufferers who had been prescribed opioids by no means took them, and 49% took just one to a few doses over the whole postoperative interval. Sufferers who did take opioids not often took them for greater than two days after surgery. Just one affected person within the non-opioid group (1%) requested for a prescription of opioids after presenting to the ED with postoperative solid discomfort.

“On condition that this examine reveals no vital profit to opioid use in controlling pain in sufferers present process CRPP for elbow fractures, suppliers and establishments ought to think about discontinuing the routine prescription of opioids following this process—and probably for different higher extremity fractures repaired utilizing CRPP,” Dr. Shah stated.

“Analysis into extra invasive pediatric orthopaedic procedures and adolescent populations might exhibit further areas for opioid stewardship. Funding into these areas will finally enhance the standard, security, and worth of surgical care in pediatric orthopaedics.”