Pain and recovery profiles following common orthopaedic surgeries in children

Abstract

Little evidence exists on the postoperative trajectory after paediatric orthopaedic surgery. Pain and behavioural disturbance can have short- and long-term impacts on children and their families. An improved understanding of procedure-specific postoperative trajectories can enhance recovery. The primary outcome was to examine the duration and severity of postoperative pain experienced by children undergoing 10 commonly performed orthopaedic procedures. Secondary outcomes include rates of behavioural disturbances, nausea and vomiting, and parental satisfaction. Parents of children were invited to participate via telephone and followed up regularly until pain, nausea and vomiting, and behavioural disturbances were at baseline. Children’s pain scores were measured using a parental proxy numerical rating scale. Three hundred and thirty-five patients were recruited across 10 routine paediatric orthopaedic surgical groups. Most (93.1%) fracture pain resolved after two days but lengthened with metal insertion or in more complex procedures such as tibial fracture manipulations and slipped upper femoral epiphysis (SUFE) pinning. Rates of postoperative nausea (24%) and vomiting (8%) were low but increased with longer operations and opioid use. Most patients received non-opioid simple analgesia on discharge, except for the SUFE pinning group, who typically received opioids for two days postoperatively. Occurrence of behavioural disturbances correlated with pain severity across groups. Pain generally resolved within two days and was managed with simple analgesia. Regional anaesthetic techniques were underutilised. Increased regional use and potentially short-term opioid analgesia at home in the SUFE and tibial fractures cohorts have been recommended at our institution. Improvement to discharge information includes procedure-specific recommendations on regular simple analgesia and expected recovery trajectory.