Percutaneous pin removal in the outpatient clinic--do children require analgesia?: a randomized controlled trial.
BACKGROUND
Percutaneous pins used in the surgical fixation of fractures in children are often removed in the outpatient clinic without the administration of analgesia. Pin removal can be a cause of anxiety for children, parents, and caregivers. Relatively little is known about the requirement of analgesia for this procedure. In a randomized controlled trial, we evaluated whether oral acetaminophen or ibuprofen reduced the pain experienced during pin removal.


METHODS
Participating in the study were 240 children between the ages of five and twelve years who had two or three percutaneous pins in the elbow following treatment of a supracondylar humeral fracture or a lateral humeral condyle fracture with closed reduction and percutaneous pinning. The patients were randomized into one of three groups (n = 80) allocated to receive acetaminophen, ibuprofen, or vitamin C (placebo) an hour before pin removal. A pain score was obtained and heart rate measured before pin removal, immediately following the procedure, and ten minutes after pin removal.


RESULTS
No significant differences were found among the study groups in terms of the demographic data of sex, age, side of injury, or number of pins. Pain score and heart rate did not exhibit differences that were either statistically significant or clinically relevant. The change from baseline did not differ significantly among the groups for either measure at either of the follow-up times post pin removal. Immediately after pin removal, the mean difference in pain score (and 95% confidence interval [CI]) between the acetaminophen group and the ibuprofen group was 0.10 (-1.03 to 1.23); between the acetaminophen group and the placebo group, 0.35 (-0.78 to 1.48); and between the ibuprofen group and the placebo group, 0.25 (-0.88 to 1.38). The CIs excluded a clinically relevant difference. Pain scores and heart rates returned to preprocedural baseline levels within ten minutes following pin removal.


CONCLUSIONS
Neither acetaminophen nor ibuprofen significantly reduced the pain score or heart rate associated with percutaneous pin removal in children as compared with the placebo. The oral analgesics administered were clinically equivalent to the placebo. These results suggest that non-narcotic analgesia use does not significantly reduce pain or heart rate associated with percutaneous pin removal in children.
Department of Orthopaedic Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899. E-mail address for K.B.L. Lim: kevin.lim.BL@kkh.com.sg.
Kevin Boon Leong
KB
Lim
Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857.
Sara Shuhui
SS
Tan
Department of Orthopaedic Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899. E-mail address for K.B.L. Lim: kevin.lim.BL@kkh.com.sg.
Sharifah Nazrah Syed
SN
Abdullah
Department of Orthopaedic Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899. E-mail address for K.B.L. Lim: kevin.lim.BL@kkh.com.sg.
Ling-Ling
LL
Ong
Department of Orthopaedic Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899. E-mail address for K.B.L. Lim: kevin.lim.BL@kkh.com.sg.
Mee-Leng
ML
Wong
Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857.
John Carson
JC
Allen
D000082:Acetaminophen / Q000627:therapeutic use*; D000284:Administration, Oral; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D001858:Bone Nails; D002648:Child; D002675:Child, Preschool; D020878:Device Removal / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000295:instrumentation*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery; D007052:Ibuprofen / Q000627:therapeutic use*; D008297:Male; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D016896:Treatment Outcome
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen; D007052:Ibuprofen