Analgesia for Kirschner wire removal in paediatric and adult populations: a narrative review.

Abstract

Removal of Kirschner (K-) wires is a frequent office-based orthopaedic procedure in both paediatric and adult populations. The optimal analgesic strategy is poorly characterised and clinical practice varies substantially across institutions and specialties. A structured PubMed search was performed in April 2026 using terms encompassing K-wire and percutaneous pin removal, analgesia, anaesthesia, sedation, and distraction. The search was supplemented by a semantic search of the Semantic Scholar / OpenAlex corpus. Studies reporting clinical outcome data on procedural pain, anxiety or analgesic strategy during K-wire or related percutaneous hardware removal in the office or outpatient setting were eligible. In paediatric populations, adequately powered randomised controlled trials demonstrate that oral paracetamol, oral ibuprofen and topical liposomal lidocaine each confer no measurable benefit over placebo. Mean procedural pain scores cluster between 3 and 4 on a ten-point scale, and a majority of caregivers do not consider pre-procedural analgesia necessary. Non-pharmacological distraction reduces both pain and anxiety; simple tablet-based distraction is non-inferior to immersive virtual reality on Level I evidence. In adults, prospective series demonstrate that awake clinic removal of percutaneous hardware without anaesthesia is well tolerated, with patient satisfaction exceeding 85%. Where pharmacological cover is required, local infiltration, ultrasound-guided regional blockade and the Wide-Awake Local Anaesthesia No Tourniquet (WALANT) technique each demonstrate equivalent or superior outcomes compared with general or spinal anaesthesia in randomised controlled trials. The most influential determinant of procedural analgesic requirements is the upstream surgical decision to leave wires exposed or to bury them at insertion. Routine pharmacological analgesia is not required for office-based K-wire removal in either paediatric or adult populations. Honest pre-procedural counselling, the selective use of non-pharmacological distraction, and graduated escalation to local, regional, WALANT or sedation techniques when clinically indicated represent the evidence-based approach. Routine recourse to general anaesthesia is not supported by the available data.