Clinical Trial: Pain Management in Children Undergoing Supracondylar Humerus Fracture Repair

Study Status: Recruiting
Recruit Status: Recruiting
Study Type: Interventional

Official Title: Pain Management in Children Undergoing Supracondylar Humerus Fracture Repair: Can a Local Supraclavicular Block Improve Their Postoperative Outcome?

Brief Summary: The purpose of this study is to determine if US-guided supraclavicular anesthetic blocks reduce postoperative pain, use of rescue medication, and improve functional outcomes in children who underwent surgery for supracondylar humerus fractures.

Detailed Summary:

Forty six American Society of Anesthesiologists (ASA) class I or II patients between the ages of 2 and 10 years undergoing reduction of supracondylar humerus fractures will be enrolled in the study. From mid-May to the beginning of August, Lurie Children's (formerly Children's Memorial Hospital)historically has 50-70 supracondylar humerus fractures in children, and we expect an 80% recruitment rate for the study. A power analysis estimated that a sample size of 46 patients would have an 80% power at the 0.05 level of significance to detect a 50% reduction in the number of patients requiring rescue medication when comparing intravenous opioids and the ultrasound-guided supraclavicular nerve block (from approximately 80% to 40%).

After obtaining informed consent, the patients will be taken to the operating room where the procedure will be performed. Intraoperatively, patients will be randomly assigned to be in one of two groups. Randomization will be determined by block allocation with a 1:1 ratio with permuted, mixed blocks of 4 and 6 created randomly using a computer based randomization table. Randomization will be performed by one of the co-investigators. Preoperatively, patients will be assessed for neurovascular status by testing the patient's ability to make three movements: thumb extension (radial nerve), proximal interphalangeal joint (PIP) flexion (median nerve), and interossei function (ulnar nerve). Patients may be removed from the study after consent is given if removal of the cast prior to surgery reveals excessive swelling in the elbow, indicating an increased likelihood for development of compartment syndrome postoperatively. This determination will be made by the attending orthopaedic surgeon performing the procedure. Patients with an increased likelihood of developing compartment syndrome will be given narcotics to treat pain.

We will record use of extra morphine in the PACU, if needed.