Perioperative Ketorolac for Supracondylar Humerus Fracture in Children Decreases Postoperative Pain, Opioid Usage, and Length of Stay

Royalty: Zimmer Biomet, Wolters Kluwer (Flynn) Perioperative administration of ketorolac in children undergoing closed reduction and percutaneous pinning for displaced supracondylar humerus fracture will lower pain scores, decrease opioid requirements, and permit earlier discharge from the hospital. This is a retrospective case-control investigation of children (aged 0–18 years) treated with closed reduction percutaneous pinning (CRPP) for closed, Gartland type III extension-type supracondylar humerus fractures at a single children's hospital between 2011 and 2017. Patients who received ketorolac perioperatively were randomly matched 1:2 by sex and age (±1 year) with patients who did not receive ketorolac. Elbow radiographs were reviewed to determine eligibility. Data abstraction included demographic and surgical details, length of stay, inpatient postoperative analgesic administration, pain ratings using the Wong-Baker FACES scale, and complications within 90 days. Differences between groups were compared with 2-tailed Mann-Whitney U and chi-square tests. 342 patients were included in the investigation including 114 patients who received ketorolac and 228 controls. Age (mean 6.2 ± 2.4 years) and sex ratio (M:F, 1.28:1) were equivalent between groups. There was also no difference in the operative time or total number of pins between groups. Mean pain rating at 0 to 29 minutes postoperatively was lower in the ketorolac group (0.7 ± 1.9) than in the control group (1.4 ± 2.6, P = .017). Mean pain rating at 30 to 120 minutes postoperatively was also lower in ketorolac group (1.1 ± 2.3) than the control group (1.7 ± 2.8, P = .036). Other pain ratings were not statistically different between groups (Figure 21-1). Patients in the ketorolac group received a lower number of inpatient oxycodone doses (1.0 ± 0.6) than did patients in the control group (1.2 ± 0.5, P = 0.003). Average postoperative morphine doses were not significantly different (0.5 ± 0.6 vs 0.6 ± 0.7, P = .137). Mean postoperative length of stay (LOS) was significantly longer for the control group (20.2 ± 11.2 hours) than the ketorolac group (13.5 ± 8.8 hours, P < .001). There was no difference in the 90-day complication rate between patients in the ketorolac group and the control group (P = .905). •There is a need for improved narcotic stewardship in orthopedic surgery.•The complementary administration of ketorolac reduces postoperative pain and opioid use in children with displaced supracondylar humerus fractures.•Ketorolac use reduces length of stay following CRPP for supracondylar humerus fractures and offers an opportunity for cost savings.