Pain Management in Acute Fracture Care

Abstract

The management of pediatric and adolescent pain continues to evolve. Similar to the adult population, pain in children is a complex process modulated by both physiologic and psychological factors. It is essential for the orthopaedic clinician who manages pain in the acute setting to understand the medical aspects of pain control in the larger context of the opioid crisis which has changed the manner in which pain management is delivered. An understanding of options for delivering analgesia is particularly important in the setting of acute fracture management. Utilization of anti-inflammatory medications, diversion techniques, and regional anesthesia are integral to management in the emergency room, preoperatively, intraoperatively, and postoperatively. A multi-faceted approach is essential to achieve successful pain management. Key Concepts: • Recent operational delays in fracture care delivery (in order to test for COVID-19) have necessitated increased attention to pediatric pain management. • The opioid crisis is a complex problem that affects both the parents and the child. • A comprehensive analgesic strategy should be used for this population in the emergency room, intraoperatively and postoperatively. • Compartment syndrome manifests differently in pediatric patients, and analgesic modalities should be chosen which do not mask its development.