Percutaneous pin removal in the outpatient clinic--do children require analgesia?: a randomized controlled trial.

BACKGROUND: Percutaneous pins used in the surgical fixation of fractures in children are often removed in the outpatient clinic without the administration of analgesia. Pin removal can be a cause of anxiety for children, parents, and caregivers. Relatively little is known about the requirement of analgesia for this procedure. In a randomized controlled trial, we evaluated whether oral acetaminophen or ibuprofen reduced the pain experienced during pin removal. METHODS: Participating in the study were 240 children between the ages of five and twelve years who had two or three percutaneous pins in the elbow following treatment of a supracondylar humeral fracture or a lateral humeral condyle fracture with closed reduction and percutaneous pinning. The patients were randomized into one of three groups (n = 80) allocated to receive acetaminophen, ibuprofen, or vitamin C (placebo) an hour before pin removal. A pain score was obtained and heart rate measured before pin removal, immediately following the procedure, and ten minutes after pin removal. RESULTS: No significant differences were found among the study groups in terms of the demographic data of sex, age, side of injury, or number of pins. Pain score and heart rate did not exhibit differences that were either statistically significant or clinically relevant. The change from baseline did not differ significantly among the groups for either measure at either of the follow-up times post pin removal. Immediately after pin removal, the mean difference in pain score (and 95% confidence interval [CI]) between the acetaminophen group and the ibuprofen group was 0.10 (-1.03 to 1.23); between the acetaminophen group and the placebo group, 0.35 (-0.78 to 1.48); and between the ibuprofen group and the placebo group, 0.25 (-0.88 to 1.38). The CIs excluded a clinically relevant difference. Pain scores and heart rates returned to preprocedural baseline levels within ten minutes following pin removal. CONCLUSIONS: Neither acetaminophen nor ibuprofen significantly reduced the pain score or heart rate associated with percutaneous pin removal in children as compared with the placebo. The oral analgesics administered were clinically equivalent to the placebo. These results suggest that non-narcotic analgesia use does not significantly reduce pain or heart rate associated with percutaneous pin removal in children.

Pain during percutaneous pin removal in children with elbow fractures.

PURPOSE: To survey caregivers with regard to the pain they perceived their children were having during the removal of the percutaneous Kirschner wires, as well as the need for analgesia. METHODS: 23 male and 18 female patients aged 1 to 15 (mean, 7) years who underwent closed reduction and percutaneous Kirschner wire fixation for elbow fractures and subsequent removal of the wires were included. Before the removal procedure, caregivers of these patients were asked to select one of 4 options for the procedure: no analgesia, paracetamol, sedation, and general anaesthesia. Approximately one month following the procedure, the caregivers were interviewed via telephone to retrospectively score the pain (on a scale of 1 to 10) they perceived their children were having during the removal procedure. RESULTS: The mean retrospective pain score given by these caregivers was 3.88. Of the 41 caregivers, 30 considered analgesia unnecessary, 10 opted for paracetamol, and only one opted for sedation. None considered general anaesthesia necessary. CONCLUSION: For these children with elbow fractures, most caregivers considered analgesia unnecessary during the removal of percutaneous wires.