title: The efficacy of intra-articular injections for pain control following the closed reduction and percutaneous pinning of pediatric supracondylar humeral fractures: a randomized controlled trial.
abstract: 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.
authors.affiliation: Children’s Hospital Colorado, Aurora, Colorado 80045, USA. Gaia.Georgopoulos@ChildrensColorado.org
authors.forename: Gaia
authors.initials: G
authors.lastname: Georgopoulos
authors.forename: Patrick
authors.initials: P
authors.lastname: Carry
authors.forename: Zhaoxing
authors.initials: Z
authors.lastname: Pan
authors.forename: Frank
authors.initials: F
authors.lastname: Chang
authors.forename: Travis
authors.initials: T
authors.lastname: Heare
authors.forename: Jason
authors.initials: J
authors.lastname: Rhodes
authors.forename: Mark
authors.initials: M
authors.lastname: Hotchkiss
authors.forename: Nancy H
authors.initials: NH
authors.lastname: Miller
authors.forename: Mark
authors.initials: M
authors.lastname: Erickson
mesh_terms: D000577:Amides / Q000627:therapeutic use*; D000704:Analysis of Variance; D000779:Anesthetics, Local / Q000627:therapeutic use; D001858:Bone Nails; D002045:Bupivacaine / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000295:instrumentation* / Q000379:methods; D006776:Hospitals, Pediatric; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D007270:Injections, Intra-Articular; D015601:Injury Severity Score; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy*; D011859:Radiography; D018570:Risk Assessment; D000077212:Ropivacaine; D016037:Single-Blind Method; D016896:Treatment Outcome; D000092464:Elbow Injuries
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D002045:Bupivacaine