DOS 2017

DOS Kongressen 2017 ·

165

Topical analgesia prior to percutaneous k-wire re-

moval in upper extremity fractures in children

Mette Sørensen Studstrup, Simon Hestbech Lundorff, Lenike Jeppesen, Niels

Krarup Jensen, Thomas Jakobsen

Department of Orthopaedic Surgery, Regional Hospital Viborg; Department of

Anesthesia abd Ubtebsive Care, Aalborg University Hospital; Department of Or-

thopaedic Surgery, Regional Hospital Viborg; Department of Orthopaedic Sur-

gery, Regional Hospital Viborg; Department of Orthopaedic Surgery, Aalborg

University Hospital

Background:

Routinely kirshner wires are left above skin level to facilitate re-

moval once the fracture is sufficiently healed. In children wire removal may be

associated with pain and discomfort. The procedure is frequently done in the

outpatient clinic without any anesthesia or analgesia.

Purpose / Aim of Study:

Prior to implementing topical analgesia as a standard

procedure, we wanted to evaluate potential benefits of topical analgesia on pain

associated with wire removal. We conducted a study comparing the intensity of

pain with or without topical analgesia.

Materials and Methods:

The study was conducted as a prospective study with

81 patients included in two consecutive groups. Mean was age 8.5 years (range

4-14). The first 40 patients were allocated to wire removal without analgesia.

The following 41 patients underwent removal after topical application of Emla

(lidocaine, prilocaine) around the wires one hour prior to the procedure. Pain

scores were recorded prior to wire removal/application of Emla and after wire

removal using FPS-R (4-12 years) and a numerical scale (1-10) (12-17 years)

indicating baseline pain and the maximum level of pain. Data were normally dis-

tributed and evaluated using student’s t-test.

Findings / Results:

We found no statistically significant effect of topical anal-

gesia vs. no topical analgesia. Both groups had similar baseline scores; mean 1.1

vs. 1.2 (p=0.78). Increase in the level of pain was 3.7 vs. 2.9 (p=0.28).

Conclusions:

Based on this study, topical analgesia does not provide any posi-

tive effect on pain related to wire removal. Besides the expenses related to ac-

quisition, application of Emla prolongs the stay in the outpatient clinic for these

young patients and may also cause local side effects. Therefore, topical analge-

sia with Emla is not warranted as a standard procedure for children undergoing

wire removal.

No conflicts of interest reported

117.