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After Elbow Surgery, Children May Be Overprescribed Opioids

Patients who had supracondylar humerus fracture sx used less than 25 percent of prescribed drugs

a boy watching TV on a hospital bed

MONDAY, Feb. 4, 2019 (Pharmacist's Briefing) -- Opioids may be overprescribed to children after orthopedic surgery for supracondylar humerus fractures, according to a study published in the Jan. 16 issue of The Journal of Bone & Joint Surgery.

Apurva Shah, M.D., from the Children's Hospital of Philadelphia, and colleagues prospectively followed 81 children (62 percent male; mean age, 6.1 years) who underwent closed reduction and percutaneous pinning of supracondylar humerus fractures at a single pediatric trauma center.

The researchers found that pain ratings (measured by Wong-Baker FACES) were highest when patients arrived to the emergency department and on the morning of postoperative day (POD) 1. By POD 3, the mean pain rating decreased to <2 and opioid doses dropped below a single dose. The decrease in postoperative opioids paralleled a decrease in reported pain. For opioid use, the interquartile range was one to seven doses and patients used only 24.1 percent of prescribed opioids (mean, 4.8 doses used and 19.8 doses prescribed). There were no significant differences in pain ratings or opioid use by fracture classification, age, or sex.

"A prescription for seven opioid doses postdischarge should allow adequate postoperative analgesia in the majority of patients while improving narcotic stewardship," the authors write.

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