SCHF Post-Op Study Between Opioid and Non-Opioid Pain Management

NCT ID: NCT06187584

Last Updated: 2026-01-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

PHASE4

Total Enrollment

160 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-04-15

Study Completion Date

2026-12-31

Brief Summary

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This purpose of this study is to determine the efficacy of nonopioid versus opioid analgesic regimens following surgical fixation of Gartland Type III Supracondylar Humoral Fractures (SCHFs) to assist in the development of a standard outpatient pain management regimen in the treatment of these injuries.

Detailed Description

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Pain is variably managed in pediatric populations, particularly in the postoperative outpatient setting. The lack of data describing and supporting the safety and efficacy of the use of analgesic drugs in children is a major contributor to this problem. Postoperative prescription opioids have been associated with high rates of morbidity and mortality in children and identified as a pathway to future opioid abuse. With increasing public awareness regarding these issues surrounding opioid use and no evidence to support superior treatment outcomes in children with the use of opioids, there is a pressing need for data to guide healthcare providers in choosing analgesic drugs to treat postoperative pain in pediatric patients.

Prior studies have evaluated the use of nonopioid versus opioid analgesic drugs in the outpatient setting following pediatric ambulatory surgery. These studies found nonopioid analgesics, such as acetaminophen and ibuprofen, to be as equally effective as opioid analgesics, including morphine, codeine and oxycodone. Further, the use of nonopioid analgesics was associated with significantly fewer side effects. These findings imply that nonopioid analgesics may be a superior initial therapy following ambulatory surgery.

However, no study has evaluated the use of nonopioid versus opioid analgesic regimens in the outpatient setting following surgical fixation of supracondylar humerus fractures (SCHFS). SCHFs are the second most common fracture in children, often requiring urgent surgical intervention. Despite their frequency, there is no standard for postoperative outpatient pain management in the treatment of these injuries.

Almost all SCHFs can be described according to the Gartland classification. The Gartland classification delineates three types of SCHFs. Gartland type I fractures are nondisplaced and do not require surgical intervention, while Gartland type II fractures are angulated, but maintain an intact posterior cortex. These may or may not require surgical intervention. However, Gartland type III fractures are completely displaced with no posterior cortical contact and require surgical intervention with either closed reduction and percutaneous pinning (CRPP) or open reduction with percutaneous pinning (ORPP). This study will look at only Gartland type III SCHFs because they necessitate surgical intervention, most commonly CRPP.

Investigators hypothesize that there is no difference in daily pain levels for nonopioid analgesic regimens compared to opioid analgesic regimens in management of post-operative pain in the outpatient period following surgical fixation of Gartland type III supracondylar humerus fracture in children.

Conditions

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Supracondylar Humerus Fracture

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Prospective, two-arm, parallel-group, randomized study conducted at a single center
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Control Group (opioid group)

Hydrocodone/acetaminophen 0.15mg/kg PO q6 hours PRN with ibuprofen 10mg/kg PO q6 hours PRN

Group Type ACTIVE_COMPARATOR

Hydrocodone/acetaminophen

Intervention Type DRUG

Hydrocodone/acetaminophen 0.15mg/kg PO q6

Ibuprofen

Intervention Type DRUG

10mg/kg PO q6 hours

Experimental Group (nonopioid group):

Acetaminophen 15mg/kg PO q6 hours with ibuprofen 10mg/kg PO q6 hours

Group Type EXPERIMENTAL

Acetaminophen

Intervention Type DRUG

15mg/kg PO q6 hours

Ibuprofen

Intervention Type DRUG

10mg/kg PO q6 hours

Interventions

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Hydrocodone/acetaminophen

Hydrocodone/acetaminophen 0.15mg/kg PO q6

Intervention Type DRUG

Acetaminophen

15mg/kg PO q6 hours

Intervention Type DRUG

Ibuprofen

10mg/kg PO q6 hours

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patients presenting to Children's Mercy Hospital
* Patients 48-119 months of age
* Closed and completely displaced Gartland type III SCHFs (ICD-10 codes: S42.411A, S42.412A and S42.413A)

Exclusion Criteria

* Patients younger than 48 months of age or older than 120 months of age
* Nondisplaced SCHFs (ICD-10): S42.414-, S42.415- and S42.416-)
* Open and completely displaced Gartland type III SCHFs (ICD-10: S42.411B, S42.412B and S42.413B)
* Injury requiring open reduction and/or vascular injury requiring treatment
* Patients presenting with additional injuries
* Patients with known allergy to medications used in this study
* Patients receiving regular treatment with opioids or NSAIDs
* Patients with underlying medical issues affecting cognitive status
* Patients with hepatic, gastrointestinal, renal or hematologic disease/disorders
* Children that are wards of the state, prisoners or of CM employees
* Non-English speaking families
* Patients not admitted before and after surgery
* Fractures not surgically treated within 18 hours of injury
* Use of local anesthetic at surgical site
Minimum Eligible Age

5 Years

Maximum Eligible Age

9 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Children's Mercy Hospital Kansas City

OTHER

Sponsor Role lead

Responsible Party

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Caleb Grote

Physician, MD/PhD

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Children's Mercy Hospital & Clinics

Kansas City, Missouri, United States

Site Status

Countries

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United States

References

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Alkhoury F, Knight C, Stylianos S, Zerpa J, Pasaron R, Mora J, Aserlind A, Malvezzi L, Burnweit C. Prospective Comparison of Nonnarcotic versus Narcotic Outpatient Oral Analgesic Use after Laparoscopic Appendectomy and Early Discharge. Minim Invasive Surg. 2014;2014:509632. doi: 10.1155/2014/509632. Epub 2014 Apr 14.

Reference Type BACKGROUND
PMID: 24834350 (View on PubMed)

Tubbs RS, Law C, Davis D, Shoja MM, Acakpo-Satchivi L, Wellons JC 3rd, Blount JP, Oakes WJ. Scheduled oral analgesics and the need for opiates in children following partial dorsal rhizotomy. J Neurosurg. 2007 Jun;106(6 Suppl):439-40. doi: 10.3171/ped.2007.106.6.439.

Reference Type BACKGROUND
PMID: 17566399 (View on PubMed)

Tobias JD. Acute pain management in infants and children-Part 1: Pain pathways, pain assessment, and outpatient pain management. Pediatr Ann. 2014 Jul;43(7):e163-8. doi: 10.3928/00904481-20140619-10.

Reference Type BACKGROUND
PMID: 24977679 (View on PubMed)

Tobias JD. Acute pain management in infants and children-Part 2: Intravenous opioids, intravenous nonsteroidal anti-inflammatory drugs, and managing adverse effects. Pediatr Ann. 2014 Jul;43(7):e169-75. doi: 10.3928/00904481-20140619-11.

Reference Type BACKGROUND
PMID: 24977680 (View on PubMed)

Poonai N, Datoo N, Ali S, Cashin M, Drendel AL, Zhu R, Lepore N, Greff M, Rieder M, Bartley D. Oral morphine versus ibuprofen administered at home for postoperative orthopedic pain in children: a randomized controlled trial. CMAJ. 2017 Oct 10;189(40):E1252-E1258. doi: 10.1503/cmaj.170017.

Reference Type BACKGROUND
PMID: 29018084 (View on PubMed)

Dorkham MC, Chalkiadis GA, von Ungern Sternberg BS, Davidson AJ. Effective postoperative pain management in children after ambulatory surgery, with a focus on tonsillectomy: barriers and possible solutions. Paediatr Anaesth. 2014 Mar;24(3):239-48. doi: 10.1111/pan.12327. Epub 2013 Dec 11.

Reference Type BACKGROUND
PMID: 24330523 (View on PubMed)

Austin AE, Shanahan ME, Zvara BJ. Association of childhood abuse and prescription opioid use in early adulthood. Addict Behav. 2018 Jan;76:265-269. doi: 10.1016/j.addbeh.2017.08.033. Epub 2017 Sep 1.

Reference Type BACKGROUND
PMID: 28869906 (View on PubMed)

Dart RC, Surratt HL, Cicero TJ, Parrino MW, Severtson SG, Bucher-Bartelson B, Green JL. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. 2015 Jan 15;372(3):241-8. doi: 10.1056/NEJMsa1406143.

Reference Type BACKGROUND
PMID: 25587948 (View on PubMed)

Cartabuke RS, Tobias JD, Taghon T, Rice J. Current practices regarding codeine administration among pediatricians and pediatric subspecialists. Clin Pediatr (Phila). 2014 Jan;53(1):26-30. doi: 10.1177/0009922813498151. Epub 2013 Aug 5.

Reference Type BACKGROUND
PMID: 23922249 (View on PubMed)

Marquis, C.P., Cheung, G., Dwyer, J.S.M., et al. "Supracondylar fractures of the humerus". Current Orthopaedics. 2008;22:62-69.

Reference Type BACKGROUND

Chaturvedi H, Khanna V, Bhargava R, Vaishya R. Predictive factors determining outcomes in pulseless limb in paediatric supracondylar fractures of humerus. J Clin Orthop Trauma. 2018 Mar;9(Suppl 1):S92-S96. doi: 10.1016/j.jcot.2017.10.009. Epub 2017 Oct 31.

Reference Type BACKGROUND
PMID: 29628707 (View on PubMed)

Woon, C., Souder, C. and Skaggs, D. "Supracondylar Fracture - Pediatric". Orthobullets. https://www.orthobullets.com/pediatrics/4007/supracondylar-fracture--pediatric. (17 July 2018).

Reference Type BACKGROUND

Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years' experience with long-term follow-up. J Bone Joint Surg Am. 1974 Mar;56(2):263-72. No abstract available.

Reference Type BACKGROUND
PMID: 4375679 (View on PubMed)

The Wong-Baker FACES Foundation: Faces of Pain Care. c2016. Published 2018. Wong-Baker FACES Foundation. [Accessed 11 Oct. 2018]. http://wongbakerfaces.org.

Reference Type BACKGROUND

Other Identifiers

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STUDY00000286

Identifier Type: -

Identifier Source: org_study_id

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