Ibuprofen demonstrated to be superior pain relief for pediatric musculoskeletal injuries
Although studies have compared the effects of oral analgesia in postoperative pediatric patients, this was the first randomized, controlled trial to compare the effects of common pain medications in children treated for acute musculoskeletal injury. The study objective was to determine which pain medication given as a single oral dose provided the most effective analgesia in this patient population.
The study included 336 patients aged 6 to 17 years presenting to the emergency department of Children's Hospital of Eastern Ontario with pain from a musculoskeletal injury to the extremities, neck, or back that occurred ≤48 hours of arrival at the emergency department. Patients were excluded if they required resuscitation, had an open fracture, had an intravenous line in place, had received acetaminophen or codeine within the previous 4 hours or ibuprofen within the previous 6 hours, had significant cognitive impairment, or had a contraindication to one of the study drugs.
A total of 300 patients (n=100 for each treatment group) were randomized to receive either acetaminophen 15 mg/kg (maximum, 650 mg), ibuprofen 10 mg/kg (maximum 600 mg), or codeine 1 mg/kg (maximum, 60 mg) after they were assesed for baseline pain score using a visual analog scale (a 100-mm hatched line ranging from "no pain" at one end of the scale to "worst pain" at the opposite end). The primary outcome was change in pain from baseline to 60 minutes after treatment with study medication; pain was measured every 30 minutes for 2 hours. Children were asked at 60 minutes and every 30 minutes thereafter if they required additional pain medication. Patients discharged before the 2-hour period were instructed to complete the remaining pain measurements at home.
There was no significant difference in pain score change between the treatment groups at 30 minutes; at 60 minutes and onward, ibuprofen was associated with significantly greater improvements in pain scores. At 60 minutes, patients who received ibuprofen had a mean 24-point pain score reduction compared with a 12-point reduction for patients who received acetaminophen and an 11-point reduction for patients who received codeine (P<.001). There was no significant difference between the acetaminophen and codeine groups throughout the study time period. The advantage for ibuprofen also was significant after 90 minutes (P=.001) and at 120 minutes (P=.004).
The number of children achieving adequate analgesia at 60 minutes was also significantly higher in the ibuprofen group compared with the acetaminophen and codeine groups (P<.001). Additional analgesic was administered to 22.2% of the children in the codeine group, 15.6% in the acetaminophen group, and 14.3% in the ibuprofen group, a nonsignificant difference (P=.32).
Clark E, Plint AC, Correll R, Gaboury I, Passi B. A randomized, controlled trial of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma. Pediatrics. 2007;119;460–467.