{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:49:47Z","timestamp":1770338987098,"version":"3.49.0"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12]]},"abstract":"Abstract<\/jats:title>\n \n Background:<\/jats:title>\n Children and adolescents are vulnerable to the ongoing opioid overdose epidemic in the United States. To minimize pediatric patients' exposure to opioids, efforts are underway to reduce opioid prescriptions after closed reduction and percutaneous pinning (CRPP) for supracondylar humerus fractures. Standardized pain management protocols preferentially using opioid-free analgesics are reported to be effective in managing postoperative pain and limiting the utilization of opioids. This study compares retrospective data collected before and after the implementation of a standardized postoperative pain management protocol at a large academic children's hospital. The primary aim of this study was to compare opioid prescription patterns during the 2 periods. The secondary aim of the study was to determine the effect of the protocol on minimizing prescription errors.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n This Institutional Review Board-approved study was a retrospective review of pediatric patients who underwent CRPP for supracondylar humerus fractures between January 2019 and December 2021. A control cohort of patients treated before the implementation of a department-approved pain management protocol was compared with a cohort of patients treated after the implementation of a standardized postoperative pain management protocol. We compared the number of opioid prescriptions provided to patients before and after the implementation of the protocol. Descriptive statistics and chi-square analyses were used to evaluate prescribing patterns.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n After the implementation of the standardized pain medication control protocol, we observed a successful decrease in pediatric patients receiving postoperative opioids from 49.6% to 13.6% and in opioid prescribing errors from 38.6% to 12.5%. In addition, there was reduced variability in the type of narcotics prescribed. After the protocol's implementation, the most common combination of medication prescribed for postoperative pain control was acetaminophen and ibuprofen (69.5%). The chi-square test demonstrated no significant association between postoperative opioid prescription and fracture classification or length of stay.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Opioid prescription patterns for postoperative pain management after CRPP for supracondylar humerus fractures were highly variable before the introduction of a standardized pain management protocol. The introduction of the standardized guideline effectively decreased the number of opioids prescribed at discharge, resulted in fewer opioid prescribing errors, and reduced variability in prescribing patterns among providers.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n Level IV\u2014retrospective case series.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/bh9.0000000000000016","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T21:00:09Z","timestamp":1770238809000},"page":"120-123","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Implementation of a standardized pain management protocol reduces the variability in prescription patterns following pediatric supracondylar humerus fractures"],"prefix":"10.1097","volume":"83","author":[{"given":"Yealeen","family":"Jeong","sequence":"first","affiliation":[{"name":"SUNY Downstate Health Sciences University, College of Medicine, Brooklyn, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Birnbaum","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Langone Health\/NYU Grossman School of Medicine, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joie","family":"Cooper","sequence":"additional","affiliation":[{"name":"Temple University, College of Public Health, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pablo","family":"Casta\u00f1eda","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine, Chief of International and Destination Surgery, Texas Children's Hospital, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mara","family":"Karamitopoulos","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedic Surgery NYU Langone Health\/Hassenfeld Children's Hospital 301 East 17th Street New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2025,12,3]]},"reference":[{"key":"R1-20260205","doi-asserted-by":"crossref","first-page":"290","DOI":"10.15585\/mmwr.mm6911a4","article-title":"Drug and opioid-involved overdose deaths\u2014United States, 2017-2018","volume":"69","author":"Wilson","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"R2-20260205","first-page":"356","article-title":"Drug overdose deaths in the United States, 1999\u20132018","author":"Hedegaard","year":"2020","journal-title":"Natl Cent Health Stat"},{"key":"R3-20260205","doi-asserted-by":"crossref","first-page":"e186558","DOI":"10.1001\/jamanetworkopen.2018.6558","article-title":"US national trends in pediatric deaths from prescription and illicit opioids, 1999-2016","volume":"1","author":"Gaither","year":"2018","journal-title":"JAMA Netw Open"},{"key":"R4-20260205","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1097\/BPO.0000000000001154","article-title":"Understanding the epidemiology of pediatric supracondylar humeral fractures in the United States: identifying opportunities for intervention","volume":"38","author":"Holt","year":"2018","journal-title":"J Pediatr Orthop"},{"key":"R5-20260205","first-page":"373","article-title":"Top 10 pediatric orthopaedic surgical emergencies: a case-based approach for the surgeon on call","volume":"60","author":"Herman","year":"2011","journal-title":"Instr Course Lect"},{"key":"R6-20260205","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1542\/peds.144.2MA8.789","article-title":"The effects of intraoperative fracture injection of bupivacaine on postoperative opioid consumption when treating supracondylar fractures of the humerus","volume":"144","author":"Kim","year":"2019","journal-title":"Pediatrics"},{"key":"R7-20260205","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1016\/j.injury.2020.10.092","article-title":"Methods to reduce opioid use during surgical treatment of pediatric supracondylar fractures\u2014a pilot study","volume":"52","author":"Kim","year":"2021","journal-title":"Injury"},{"key":"R8-20260205","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1097\/BPO.0000000000001345","article-title":"Perioperative ketorolac for supracondylar humerus fracture in children decreases postoperative pain, opioid usage, hospitalization cost, and length-of-stay","volume":"39","author":"Adams","year":"2019","journal-title":"J Pediatr Orthop"},{"key":"R9-20260205","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.amjsurg.2017.10.035","article-title":"Variation in post-discharge opioid prescriptions among members of a surgical team","volume":"216","author":"Blay","year":"2018","journal-title":"Am J Surg"},{"key":"R10-20260205","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.bpa.2019.07.009","article-title":"Perioperative use of opioids: current controversies and concerns","volume":"33","author":"Alexander","year":"2019","journal-title":"Best Pract Res Clin Anaesthesiol"},{"key":"R11-20260205","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1097\/EJA.0000000000000964","article-title":"Opioid-free anaesthesia: still a debate?","volume":"36","author":"Veyckemans","year":"2019","journal-title":"Eur J Anaesthesiol"},{"key":"R12-20260205","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1016\/j.jsurg.2021.03.005","article-title":"A standardized order-set improves variability in opioid discharge prescribing patterns after surgical fixation of pediatric supracondylar humerus fractures","volume":"78","author":"Goodloe","year":"2021","journal-title":"J Surg Educ"},{"key":"R13-20260205","first-page":"581","article-title":"Reducing the use of opioids for pediatric patients with supracondylar humerus fractures","volume":"46","author":"Winslow","year":"2020","journal-title":"Jt Comm J Qual Patient Saf"},{"key":"R14-20260205","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1097\/BPO.0000000000001639","article-title":"Pain control and medication use in children following closed reduction and percutaneous pinning of supracondylar humerus fractures: are we still overprescribing opioids?","volume":"40","author":"Stillwagon","year":"2020","journal-title":"J Pediatr Orthop"},{"key":"R15-20260205","first-page":"282","article-title":"Opioid prescription patterns in pediatric orthopedics following closed reduction and percutaneous pinning for supracondylar humerus fractures","volume":"80","author":"Birnbaum","year":"2013","journal-title":"Bull Hosp Joint Dis"},{"key":"R16-20260205","doi-asserted-by":"crossref","first-page":"119","DOI":"10.2106\/JBJS.18.00657","article-title":"Postoperative pain and opioid use in children with supracondylar humeral fractures: balancing analgesia and opioid stewardship","volume":"101","author":"Nelson","year":"2019","journal-title":"J Bone Joint Surg Am"},{"key":"R17-20260205","doi-asserted-by":"crossref","first-page":"2287","DOI":"10.2147\/JPR.S144066","article-title":"Poorly controlled postoperative pain: prevalence, consequences, and prevention","volume":"10","author":"Gan","year":"2017","journal-title":"J Pain Res"},{"key":"R18-20260205","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1097\/BPO.0b013e318259f85a","article-title":"Postoperative pain control after supracondylar humerus fracture fixation","volume":"32","author":"Swanson","year":"2012","journal-title":"J Pediatr Orthop"},{"key":"R19-20260205","doi-asserted-by":"crossref","first-page":"e0257021","DOI":"10.1371\/journal.pone.0257021","article-title":"An observational cohort study comparing ibuprofen and oxycodone in children with fractures","volume":"16","author":"Ali","year":"2021","journal-title":"PLoS One"},{"key":"R20-20260205","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1016\/j.jamcollsurg.2007.09.006","article-title":"A randomized controlled trial comparing acetaminophen plus ibuprofen versus acetaminophen plus codeine plus caffeine after outpatient general surgery","volume":"206","author":"Mitchell","year":"2008","journal-title":"J Am Coll Surg"}],"container-title":["Bulletin of the Hospital for Joint Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/bh9.0000000000000016","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T12:00:22Z","timestamp":1770292822000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/bh9.0000000000000016"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":20,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.1097\/bh9.0000000000000016","relation":{},"ISSN":["2328-5273"],"issn-type":[{"value":"2328-5273","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]}}}