A Randomized Clinical Trial of Ibuprofen Versus Acetaminophen With Codeine for Acute Pediatric Arm Fracture Pain

Drendel, Amy L.; Gorelick, Marc H.; Weisman, Steven J.; Lyon, Richard H.; Brousseau, David C.; Kim, Michael K.

doi:10.1016/j.annemergmed.2009.06.005

Cited by 131 publications

(136 citation statements)

References 26 publications

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“…[3][4][5] Both the injury itself and the required interventions (i.e., cast application) can be painful, with most children who have sustained limb trauma reporting moderate pain in the ED and after discharge. [6][7][8] The World Health Organization (WHO) has declared that pediatric pain treatment is a public health concern of major significance. 9 Inadequate pain treatment during medical care, especially among young children, can have numerous detrimental effects.…”

Section: Ré Sumémentioning

confidence: 99%

Pediatric musculoskeletal pain in the emergency department: a medical record review of practice variation

Kircher

Drendel

Newton

et al. 2014

CJEM

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Objective: Musculoskeletal (MSK) injuries are a common, painful pediatric presentation to the emergency department (ED). The primary objective of this study was to describe current analgesic administration practices for the outpatient management of children's MSK pain, both in the ED and postdischarge. Methods: We reviewed the medical records of consecutive pediatric patients evaluated in either a pediatric or a general ED (Edmonton, Alberta) during four evenly distributed calendar months, with a diagnosis of fracture, dislocation, strain, or sprain of a limb. Abstracted data included demographics, administered analgesics, pain scores, discharge medication advice, and timing of clinical care. Results: A total of 543 medical records were reviewed (n 5 468 pediatric ED, n 5 75 general ED). Nineteen percent had documented prehospital analgesics, 34% had documented in-ED analgesics, 13% reported procedural sedation, and 24% documented discharge analgesia advice. Of those children receiving analgesics in the ED, 59% (126 of 214) received ibuprofen. Pain scores were recorded for 6% of patients. At discharge, ibuprofen was recommended to 47% and codeine-containing compounds to 21% of children. The average time from triage to first analgesic in the ED was 121 6 84 minutes. Conclusions: Documentation of the assessment and management of children's pain in the ED is poor, and pain management appears to be suboptimal. When provided, ibuprofen is the most common analgesic used for children with MSK pain. Pediatric patients with MSK pain do not receive timely medication, and interventions must be developed to improve the ''door to analgesia'' time for children in pain. RÉ SUMÉObjectif: Les blessures musculosquelettiques (MS) douloureuses chez les enfants sont un motif fré quent de consultation au service des urgences (SU). L'é tude avait pour objectif principal de dé crire les pratiques actuelles de l'administration des analgé siques dans la prise en charge des douleurs MS, en mode ambulatoire, tant au SU qu'à domicile, aprè s le congé de l'hô pital. Mé thode: Ont é té passé s en revue les dossiers mé dicaux d'enfants consé cutifs, examiné s dans un SU gé né ral ou un SU pé diatrique (Edmonton [Alberta]) au cours de quatre mois civils ré partis é galement, pour un diagnostic de fracture, de dislocation, de foulure ou d'entorse d'un membre. Les renseignements recueillis comprenaient des donné es dé mographiques, les analgé siques administré s, les cotes de la douleur, les conseils sur les mé dicaments donné s au moment du congé et la duré e des soins cliniques. Ré sultats: Au total, 543 dossiers mé dicaux ont é té examiné s (n 5 468 au SU pé diatrique; n 5 75 au SU gé né ral). Dans 19% d'entre eux é tait consigné e la prise d'analgé siques en phase pré hospitaliè re; dans 34%, l'administration d'analgé siques au SU; dans 13%, l'administration de sé dation-analgé sie à des fins interventionnelles; et dans 24%, la prestation de conseils sur l'analgé sie au moment du congé . Parmi les enfants à qui l'on a prescrit des ana...

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Section: Ré Sumémentioning

confidence: 99%

Pediatric musculoskeletal pain in the emergency department: a medical record review of practice variation

Kircher

Drendel

Newton

et al. 2014

CJEM

Self Cite

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“…Th ree articles compared fentanyl and morphine (PICO #1); fi ve articles assessed hydromorphone (PICO #2), two of which analyzed the 1 + 1 hydromorphone protocol (PICO #3); three articles compared oral hydromorphone and oxycodone (PICO #4); eight articles compared non-specifi c NSAIDs and co deine-acetaminophen (PICO #5); two articles compared specifi c NSAIDs and co deine-acetaminophen (PICO #6); and fi ve articles compared oxycodone and codeine (PICO #7). Th e same reviewer assessed the full text articles and determined that 14 of the 26 off ered quantitative results that could be analyzed using the GRADE-pro software [28][29][30][31][32][33][34][35][36][37][38][39][40][41]. Th e remaining 12 articles were excluded because they did not compare both drugs assessed in a PICO question [42][43][44][45][46][47], compared analgesics not addressed in the seven P ICO qu estions (such as acetaminophen alone) [48,49], used unconventional medication dosing [50,51], used non-validated pain me asurement scales [52,53], and/or unusual study designs [50].…”

Section: Resultsmentioning

confidence: 99%

“…However, although the number of studies used to make our recommendations may seem low, our re commendations take into consideration the quality of evidence of the studies. Pragmatic derivations of the seven PICO questions, their recommendations, and the rationale for these recommendations are listed in Table 4 [28][29][30][31][32][33][34][35][36][37][38][39][40][41]. Furthermore, we also developed a fl owchart as a suggested approach to analges ia in the ED (Fig.…”

Section: Discussionmentioning

confidence: 99%

Analgesia in the Emergency Department: A GRADE-based Evaluation of Research Evidence and Recommendations for Practice

Lipp

Dhaliwal

Lang

2013

Annual Update in Intensive Care and Emergency Medicine 2013

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Emergency physicians care for patients with pain on an extremely frequent basis [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Th e prevalence of pain as the presenting complaint of patients seeking eme rgen cy department (ED) care ranges from 38 % [3] to as high as 78 % [1]. As a result, evidence-based use of analgesics should be a foundational skill of emergency physicians. However, the literature consistently reports that emergency physicians are ofte n poor at treating pain [1,2,8,13,14,16,19,20] . Notwithstanding the prevalence of pain in the ED, many patients often report that their pain was no t pr oper ly t reated [3,7,20]. I n addi tion to a compromised patient experience, sub-optimal treatment of pain will result in decreased department fl ow, increased wait times, more return visits to the ED, and increased hospitalization rates.Very few evidence-based resources and guideli nes exis t to inform emergency physicians on how to treat pain. One recent guideline on acute pain management compiled by the college of Anaesthetists of Australia and New Zealand [21] was focused primarily on treating pain perioperatively and did not include stratifi ed or graded recommendations based on the literature, highlighting the paucity of emergency medicine-specifi c guidance. Emergency physicia ns need an eff ective, evidenced-based approach to analyze and apply the options available for acute pain management.Th e objective of this article is to synthesize and evaluate the quality of medical literature surrounding analgesia delivery in the adult ED using the Grading Assessment, Development and Evaluation (GRADE) framework. We further strived to provide emergency physicians with graded recommendations upon which analgesics should be used to treat adults with acute pain in the ED. Question formulationPrior to searching the literature we developed seven clinically-oriented questions based on a scoping of the literature and a review of locally utilized ED analgesic order sets. Th is initial surveying of medical literature and our local practice environment allowed us to identify the most commonly prescribed intravenous and oral analgesics used in adult EDs in our health care region.We then used the patient-intervention-comparisonoutcome (PICO) approach to develop our seven research questions (Table 1). Th is approach has been adopted by many authors of systematic reviews and guideline panels, including the Internati onal Liaison Committee on Resuscitation (ILCOR) and the American College of Chest Physicians (ACCP) [22][23][24]. It involves identifying a specifi c population or setting to which recommen dations may be applied. Subseq uently each question compares two specifi c management strategies (intervention and comparison). Fi nally, we defi ned important patient oriented outcomes (e. g., change in pain) as well as any adverse eff ects of the medication or other safety concerns.All seven draft questions were reviewed and revised through an iterative process involving all authors. Th ese seven cl...

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“…23 Evaluation of a randomized, double-blind trial that examined the oral administration of ibuprofen versus acetaminophen with codeine for pediatric arm fracture revealed a 4.1% difference in adverse effects between the 2 interventions; however, respiratory depression was not separately stratified. 24 A comparison of oral acetaminophen with codeine versus ibuprofen for pain in postoperative tonsillectomy patients was performed. 25 No respiratory effects were reported during the trial.…”

Section: Resultsmentioning

confidence: 99%

Opioid Use and the Risk of Respiratory Depression and Death in the Pediatric Population

Whittaker

2013

The Journal of Pediatric Pharmacology and Therapeutics

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BACKGROUND Pediatric patients may be at an increased risk of adverse effects from various medications. Recently, there have been a number of serious adverse events, including several pediatric patients experiencing severe respiratory depression and death as a result of the use of codeine for pain control following tonsillectomy and adenoidectomy. OBJECTIVE To assess the safety of opioid agonists in pediatric patients undergoing operative procedures or have experienced trauma and to evaluate the risk of respiratory depression and death among this population. METHODS PubMed and Medline were searched to identify randomized controlled studies from 1994 to 2012 addressing postsurgery/trauma opioid use in pediatric patients. Relative risks and confidence intervals (CIs) were calculated using data available in clinical trials. RESULTS A total of 16 clinical trials were evaluated for this review. Randomized controlled trials included studies comparing opioids versus non-opioids for a variety of painful conditions. The relative risk of respiratory depression associated with opioid use in 1 trial was 1.63 (95% CI: 0.64-6.13). The remaining 15 trials reviewed described no significant difference in respiratory depression or adverse effects associated with treatment. No deaths were attributed to opioid use in any of these studies. CONCLUSION Opioid-associated respiratory depression was very rare and no deaths were reported in the reviewed studies. These findings under the well-defined conditions of controlled studies may not be the best means of determining overall opioid-associated side effects in pediatric patients. INDEX TERMS

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A Randomized Clinical Trial of Ibuprofen Versus Acetaminophen With Codeine for Acute Pediatric Arm Fracture Pain

Cited by 131 publications

References 26 publications

Pediatric musculoskeletal pain in the emergency department: a medical record review of practice variation

Pediatric musculoskeletal pain in the emergency department: a medical record review of practice variation

Analgesia in the Emergency Department: A GRADE-based Evaluation of Research Evidence and Recommendations for Practice

Opioid Use and the Risk of Respiratory Depression and Death in the Pediatric Population

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