RT Journal
A1 Georgopoulos, Gaia
A1 Carry, Patrick
A1 Pan, Zhaoxing
A1 Chang, Frank
A1 Heare, Travis
A1 Rhodes, Jason
A1 Hotchkiss, Mark
A1 Miller, Nancy H.
A1 Erickson, Mark
T1 The Efficacy of Intra-Articular Injections for Pain Control Following the Closed Reduction and Percutaneous Pinning of Pediatric Supracondylar Humeral FracturesA Randomized Controlled Trial
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2012
FD September 19
VO 94
IS 18
SP 1633
OP 1642
DO 10.2106/JBJS.K.01173
UL http://dx.doi.org/10.2106/JBJS.K.01173
AB Background: 
  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.Methods: 
  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.Results: 
  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.Conclusions: 
  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.