Opioid Use Following Operatively Treated Pediatric Elbow and Femur Fractures

BACKGROUND Opioids are a commonly utilized component of pain management following pediatric extremity fractures, yet an increasing number of adolescents and children are falling victim to their negative effects. The purpose of this study was to examine opioid use in the pediatric fracture population by determining and comparing the average hospital opioid dosage utilized in the operative pediatric elbow and femur fractures and determining and comparing the average dose prescribed following operative treatment of elbow and femur fractures.
METHODS All elbow and femur fractures treated operatively between January and December 2016 were identified. Patients aged 0 to 17 years with closed injuries who presented to the emergency department (ED) within 24 hours of injury and underwent operative treatment were included. Demographic information, opioid and nonopioid analgesic medication doses administered in the ED and while inpatient, and postdischarge prescription information were recorded. Opioid doses were converted to oral morphine equivalents.
RESULTS In total, 91.9% and 78.1% of patients received opioids during the ED and inpatient periods, respectively. Only 30% of patients in either cohort received a nonopioid analgesic in the ED and only 44% received ibuprofen while inpatient. Average total opioid dose per hour of hospital stay was not significantly different between elbow fracture and femur fracture cohorts, which was unexpected. There was no significant difference between the average opioid dose or number of doses prescribed for postdischarge use between cohorts.
CONCLUSIONS This study provides data on average hospital opioid and nonopioid use following pediatric elbow and femur fractures. The results reveal inconsistent nonopioid analgesic use and similar hospital opioid use in elbow and femur fracture patients. This study provides baseline analgesic use data for future investigations.
LEVEL OF EVIDENCE Level IV.

as reported in: J Pediatr Orthop. 2018 Nov 13 [Epub ahead of print]