Post-operative Pain Management in Children With Supracondylar Humerus Fractures

Study Overview
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Brief Summary
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There are two common and concurrently used strategies for pain management following surgical treatment of supracondylar humerus (elbow) fractures in children: opioids vs over the counter pain medications. The purpose of this study is to determine if ibuprofen and acetaminophen can provide similar or better pain relief compared to ibuprofen and hydrocodone/acetaminophen (also known as Hycet) for this population of children after they have been discharged. If over the counter medications can provide adequate pain relief, then fewer opioid prescriptions would be necessary. This reduces early opioid exposure and decreases unnecessary opioids in circulation.

Detailed Description
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Prior to surgery, participants will be randomly assigned to a group that will determine whether they are prescribed an opioid vs non-opioid pain management plan at discharge. Each participants' parent or guardian will be given a journal to keep track of their child's pain severity and the pain medications taken. The journal will updated daily until participants no longer require pain medication. Participants will follow up with their surgeon per usual at their post-operative visits.

Official Title
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A Randomized Controlled Trial of Opioid vs Non-Opioid Postoperative Pain Management in Children With Supracondylar Humerus Fractures

Conditions
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Supracondylar Humerus Fracture

Intervention / Treatment
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* Drug: Ibuprofen
* Drug: Hydrocodone/acetaminophen
* Drug: Acetaminophen


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Closed, Gartland type III supracondylar humerus fracture Fractures treated with closed reduction and percutaneous pinning (CRPP) Patients expected to follow up at Texas Children's Hospital Patients/guardians must speak English or Spanish Exclusion Criteria: Fractures associated with open skin wounds, polytrauma, neurologic deficit, or vascular deficit Patients who have impaired ability to report pain severity such as intellectual delay. Patients who have a problem with bone healing such as osteogenesis imperfecta. Patients who are unable to take the standard dose of acetaminophen, ibuprofen, or hydrocodone (allergy, severe kidney disease, etc). Patients who are on chronic NSAID or opioid medication prior to injury. Patients with injury from suspected non-accidental trauma.

Ages Eligible for Study
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Minimum Age: 3 Years
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Opioid Pain Management<br>Ibuprofen (liquid, 10mg/kg/dose every 6 hours) will be the first line pain medication and Hydrocodone/Acetaminophen (liquid, 0.135mg Hydrocodone/kg/dose every 6 hours) will be used as needed for breakthrough pain. | Drug: Ibuprofen<br>* Non-opioid<br>* Other names: Motrin, Advil;Drug: Hydrocodone/acetaminophen<br>* Opioid<br>* Other names: Hycet;|
| Experimental: Non-Opioid Pain Management<br>Ibuprofen (liquid, 10mg/kg/dose every 6 hours) will be the first line pain medication and Acetaminophen (liquid, 15mg/kg/dose every 6 hours) will be used as needed for breakthrough pain. | Drug: Ibuprofen<br>* Non-opioid<br>* Other names: Motrin, Advil;Drug: Acetaminophen<br>* Non-opioid<br>* Other names: Tylenol;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Daily Pain Scores on the FACES Scale | A parent/guardian will ask participants to rate their pain severity using the Wong-Baker FACES scale, which ranges from 0 (no pain) to 10 (worst pain). | from discharge until pain medication is no longer required (assessed up to 3 weeks) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Pain Medication Doses Required per Day | A parent/guardian will record the doses of pain medications given to the participant each day. | from discharge until pain medication is no longer required (assessed up to 3 weeks) | 
| Number of Days Pain Medication Required | A parent/guardian will record the doses of pain medications given to the participant each day. | from discharge until pain medication is no longer required (assessed up to 3 weeks) |