The effects of intraoperative fracture injection of bupivacaine on postoperative opioid consumption when treating supracondylar fractures of the humerus

• Published in: Pediatrics (Evanston) 2019-08, Vol.144 (2_MeetingAbstract), p.789-789
• Main Authors: Kim, Kelvin, Hennrikus, Wiiliam, Armstrong, Douglas G.
• Format: Article
• Language: English
• Subjects: Abuse; Acetaminophen; Analgesics; Bupivacaine; Children; Drug abuse; Epidemics; Fractures; Humerus; Injection; Medical personnel; Morphine; Narcotics; Opioids; Pain; Patients; Pediatrics; Surgery
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.144.2MA8.789

Objective: The current opioid epidemic is a national problem and an increasing concern for pediatric orthopaedic patients. The use of non-opioid methods to reduce pain may help curb the over-prescribing and overuse of opioid medications. The present study aims to compare the effects of an intraoperative bupivacaine fracture injection on postoperative opioid consumption when treating supracondylar fractures of the humerus. Methods: 42 consecutive patients treated for a type III supracondylar extension-type fracture of the humerus by 2 surgeons were reviewed. Two cohorts (21 patients each) were compared based on whether patients received an intraoperative fracture injection of bupivacaine. In 21 cases the fracture was injected with 5 cc of bupivacaine through posteriorly the triceps prior to fracture reduction. Data variables evaluated included baseline patient characteristics, postoperative inpatient analgesic use, and the amount of opioids prescribed at discharge. Results: During the time interval of ≥12 hours following surgery, patients who received intraoperative BP injected into the fracture consumed less analgesic doses compared to their non-BP counterparts (0.4 ± 0.5 versus 0.9 ± 1.0; p=0.047) (Table 1). Furthermore, the BP cohort received a lesser number of opioid doses during the total postoperative hospital stay (2.1 ± 1.8 versus 3.6 ± 2.5; p=0.031) and at discharge (0.1 ± 0.4 versus 0.7 ± 1.3; p=0.040). When the BP cohort was stratified by patients who did and did not receive intraoperative acetaminophen, during their total postoperative hospital stay, the acetaminophen group consumed analgesic medication less frequently (p=0.005), consumed less opioid doses (p=0.011), and consumed less morphine-milligram-equivalents of opioids (p=0.043) (Table 2). Conclusion: Opioid abuse and overuse in children has become a national healthcare crisis. The use of bupivacaine injected into the fracture at the time of surgery is safe, effective, and reduces the need for opioids. We recommend a routine intraoperative fracture injection with bupivacaine when treating children with supracondylar fractures of the humerus.