What did the study look at?
The authors note that anterior cruciate ligament (ACL) injuries and operations are becoming more common in patients aged 17 or under. Good pain control after surgery matters for early mobilisation and timely discharge, yet evidence on pre- and postoperative pain protocols in children is limited. The study aimed to describe variation in pain management protocols and prescribing patterns for children undergoing ACL reconstruction or repair.
How was it done?
This was a survey study: no measurements were taken on patients; surgeons reported their own practice.
- A 20-question multiple-choice online survey was posted on the websites of three orthopaedic societies (AOSSM, AANA and ESSKA) for 60 days, from October to December 2020.
- Questions covered surgeon characteristics, nerve blocks and pre- and postoperative pain control. The questions had not been validated beforehand.
- Agreement by more than 80% of respondents was defined as "clinical agreement" and by more than 60% as "general agreement". No statistical tests were performed.
What did it find?
- Of 84 surveys returned, 68 (81%) were complete and analysed. 63% of respondents had fellowship training in paediatric orthopaedics.
- 72% used a peripheral nerve block (an injection that numbs a nerve territory) before surgery, most often an adductor canal block (60%); 87% of blocks were single-shot.
- Pre-emptive analgesia (painkillers given before surgery) was used by 28%; 63% of these surgeons said the decision was based on the anaesthetist's preference.
- Opioids were prescribed after surgery by 88% of respondents. For the standard prescription, 48% gave 11 to 19 tablets and 15% gave 20 or more.
- 85% said they "always" give written or verbal advice on pain control, yet 63% said they give no instructions to patients and parents on disposing of unused opioid tablets.
- All surgeons reported that patients generally took opioid painkillers for 2 weeks or less, and 68% said less than 1 week.
- 99% did not change their pain protocol when a meniscal repair or meniscectomy was added.
The authors' conclusion
The authors conclude that pain management before and after ACL surgery in children remains varied, that opioids are frequently prescribed after surgery, and that many providers do not give instructions on disposing of excess tablets. They suggest that clinical guidelines aiming for safe pain control while minimising opioid prescribing and use should be considered.
Limitations
- The survey reached only members of orthopaedic societies, introducing sampling bias, and the response rate was relatively low.
- Most questions were closed-ended, so the options may not cover all possible answers; for example, the number of tablets rather than doses was asked.
- Answers, particularly on how long patients took opioids, may be affected by recall bias.
Reference
Perry AK, McCormick JR, Knapik DM, Maheshwer B, Gürsoy S, Kogan M, Chahla J. 2021. Overprescribing and Undereducating: a Survey of Pre- and Postoperative Pain Protocols for Pediatric Anterior Cruciate Ligament Surgery. Arthroscopy, Sports Medicine, and Rehabilitation. 3(6):e1905–e1912. Licence: CC BY-NC-ND 4.0.
DOI: 10.1016/j.asmr.2021.09.008
Free full text: PubMed Central PMC8689250
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
