Variability Exists in Pain Management Practices for Pediatric ACL Reconstruction

Abstract

Background:Effective pain management for anterior cruciate ligament (ACL) reconstruction may improve both patient satisfaction and function. However, there is limited data supporting clear guidelines regarding pain management for ACL reconstruction in the pediatric population.Hypothesis/Purpose:The purpose of this study is to survey current pain management practices for ACL reconstruction among pediatric orthopaedic surgeons.Methods:A cross-sectional survey study was conducted in which orthopaedic surgeons were asked about their pain management practices for pediatric ACL reconstruction. The voluntary survey was sent to members of the Pediatric Orthopaedic Society of North America (POSNA). Inclusion criteria were performs ACL repair or reconstruction on patients under age eighteen and willing to participate in the survey. Responses were anonymous and consisted of demographics, training, current practice, and pain management strategies. Survey data were assessed using descriptive statistics, Pearson’s chi-squared test and Fisher’s exact test for categorical variables, and two-sample t-test for continuous variables.Results:There were 77 responses, of which 64 fit the inclusion criteria. The average age of respondents was 48.9 years, 84.4% were male, and 31.3% practiced in the southern region of the US (Table 1). 39.1% of respondents utilized preemptive analgesia, 90.6% utilized perioperative blocks, 82.8% routinely advocated for scheduled non-narcotic medications post-operatively, and 93.8% recommended cryotherapy post-operatively (Table 2). Respondents that reported not using a peri-operative block and not advocating for scheduled non-narcotic pain management post-operatively were older on average than those that did (57.6 vs. 47.7 years, p=0.04; 56.7 vs. 47.0 years, p<0.01; respectively).Acetaminophen was the most commonly used pre-operative medication (31.3%), the most common perioperative block was an adductor canal block (73.4%), and the most typically prescribed post-operative analgesic medication was ibuprofen (60.9%). Most respondents reported prescribing 10-20 opioid pills (46.9%), 20.3% prescribed >20 opioid pills, and 10.9% did not prescribe opioid pain medication at all. In total, 89.1% of respondents reported prescribing opioid pain medication post-operatively, however, only 59.4% reported counseling patients on appropriate disposal of extra pills. Prior training or experience was more frequently reported than published research as a primary factor influencing pain management protocols.Conclusion:Significant variability exists in pain management practices in pediatric ACL reconstruction. There is a need for more evidence-based practice guidelines regarding pain management.Table 1.Demographics (N=64)Table 2.Pain Management Practices