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The Efficacy of Intra-Articular Injections for Pain Control Following the Closed Reduction and Percutaneous Pinning of Pediatric Supracondylar Humeral FracturesA Randomized Controlled Trial
Gaia Georgopoulos, MD1; Patrick Carry, BA1; Zhaoxing Pan, PhD1; Frank Chang, MD1; Travis Heare, MD1; Jason Rhodes, MD1; Mark Hotchkiss, BA1; Nancy H. Miller, MD1; Mark Erickson, MD1
1 The Children’s Hospital Colorado, 13123 East 16th Avenue, B060, Aurora, CO 80045. E-mail address for G. Georgopoulos: Gaia.Georgopoulos@ChildrensColorado.org
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Investigation performed at Children’s Hospital Colorado, Aurora, Colorado

This article was chosen to appear electronically on August 8, 2012, in advance of publication in a regularly scheduled issue.

A commentary by Paul D. Sponseller, MD, MBA, is linked to the online version of this article at jbjs.org.

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Sep 19;94(18):1633-1642. doi: 10.2106/JBJS.K.01173
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The purpose of this single-blinded, randomized, controlled trial was to compare the analgesic efficacy of intra-articular injections of bupivacaine or ropivacaine with that of no injection for postoperative pain control after the operative treatment of supracondylar humeral fractures in a pediatric population.


Subjects (n = 124) were randomized to treatment with 0.25% bupivacaine (Group B) (n = 42), 0.20% ropivacaine (Group R) (n = 39), or no injection (Group C) (n = 43). The opioid doses and the times of administration as well as child-reported pain severity (Faces Pain Scale-Revised) and parent-reported pain severity (Total Quality Pain Management survey) were recorded.


The proportion of subjects who required morphine and/or fentanyl injections was significantly (p = 0.004) lower in Group B (10%) as compared with Group R (36%) and Group C (44%). On the basis of the log-rank test, the opioid-free survival rates were significantly greater in Group B as compared to Groups C and R. Total opioid consumption (morphine equivalent mg/kg) in the first seventy-two hours postoperatively was significantly less in Group B as compared with Group C (mean difference, 0.225; [95% confidence interval (CI), 0.0152 to 0.435]; p = 0.036). Parent-reported pain scores were also significantly lower in Group B as compared with both Group C (mean difference, 1.81 [95% CI, 0.38 to 3.25]; p = 0.014) and Group R (mean difference, 1.66; 95% CI, 0.20 to 3.12; p = 0.027). There were no significant differences across the three groups in terms of self-reported pain. Differences between Groups R and C were not significant for any of the outcome variables.


The intra-articular injection of 0.25% bupivacaine significantly improves postoperative pain control following the closed reduction and percutaneous pinning of supracondylar humeral fractures in pediatric patients.

Level of Evidence: 

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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