Do kids with forearm fractures need opioids at discharge from the emergency department? Analgesic prescribing and pain control following closed reduction of pediatric forearm fractures

Abstract

Abstract Objective The purpose of this 2‐part study is to determine opioid prescribing patterns and opioid use and pain control after discharge following closed reduction of pediatric forearm fractures. Methods A retrospective study was conducted from December 2016 to January 2018 at a level 1 trauma center to determine opioid prescribing habits for patients 1–17 years old with forearm fractures treated with closed reduction. A prospective study was then conducted from August 2019 to October 2020 to determine pain control and opioid use after discharge. Data were collected through chart review and with telephone surveys on post‐discharge days 1, 3, and 5 to collect pain scores and opioid use. Results Fifty patients with a median age of 8 (interquartile range [IQR], 5–11) years old and 51 patients with a mean age of 9 (IQR, 6–11) years old were included in the retrospective and prospective cohorts, respectively. From the retrospective study, 21 patients (42%) were prescribed a median of 10 opioid doses (IQR, 8–12) at discharge. From the prospective study, 12 patients (24%) were discharged with a median of 8 opioid doses (IQR, 5.5–10), for a total of 98 total doses. Of those, only 7 doses (7%) were used by 3 patients. Higher weight and initial pain score were associated with increased rates of opioid prescription. Conclusions Pediatric patients who undergo closed reduction of a forearm fracture under procedural sedation in the emergency department are prescribed approximately 14 times the amount of opioid that is used. We propose that prescribing only non‐opioid analgesics to these patients would afford equivalent pain control without the side‐effects and abuse potential of opioid use at an early age.

Keywords

• analgesics
• closed reduction
• forearm fracture
• opioids
• pain
• pain management