A Randomized, Controlled Trial of Acetaminophen, Ibuprofen, and Codeine for Acute Pain Relief in Children With Musculoskeletal Trauma

Clark, Eric; Plint, Amy C.; Correll, Rhonda; Gaboury, Isabelle; Passi, Brett

doi:10.1542/peds.2006-1347

Cited by 180 publications

(154 citation statements)

References 43 publications

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“…Ibuprofen appears to have emerged as a reasonable first-line medication for mild to moderate pain. 39,40 Oxycodone and oral morphine may be feasible alternatives or adjuncts for moderate to severe pain and are gaining popularity with clinicians. Further research is needed to determine the optimal opioid analgesic for moderate to severe pain in children.…”

Section: Discussionmentioning

confidence: 99%

Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

Ali

Chambers

Johnson

et al. 2014

CJEM

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Objectives: To describe pediatric emergency medicine (PEM) physicians' reported pain management practices across Canada and explore factors that facilitate or hinder pain management. Methods: This study was a prospective survey of Canadian pediatric emergency physicians. The Pediatric Emergency Research Canada physician database was used to identify participants, and a modified Dillman's Total Design Survey Method was used for recruitment.Results: The survey response rate was 68% (139 of 206). Most physicians were 31 to 50 years old (82%) with PEM training (56%) and had been in practice for less than 10 years (55%). Almost all pain screening in emergency departments (EDs) occurred at triage (97%). Twenty-four percent of physicians noted institutionally mandated pain score documentation. Ibuprofen and acetaminophen were commonly prescribed in the ED for mild to moderate pain (88% and 83%, respectively). Over half of urinary catheterizations (60%) and intravenous (53%) starts were performed without any analgesia. The most common nonpharmacologic interventions used for infants and children were pacifiers and distraction, respectively. Training background and gender of physicians affected the likelihood of using nonpharmacologic interventions. Physicians noted time restraints to be the greatest barrier to optimal pain management (55%) and desired improved access to pain medications (32%), better policies and procedures (30%), and further education (25%). Conclusions: When analgesia was reported as provided, ibuprofen and acetaminophen were most commonly used. Both procedural and presenting pain remained suboptimally managed. There is a substantial evidence practice gap in children's ED pain management, highlighting the need for further knowledge translation strategies and policies to support optimal treatment. RÉ SUMÉObjectifs: L'é tude visait à dé crire les pratiques, dé claré es par les inté ressé s, en matiè re de prise en charge de la douleur en mé decine d'urgence pé diatrique (MUP), au Canada, et à examiner les facteurs qui facilitent ou, au contraire, entravent le traitement de la douleur. Mé thodes: Il s'agit d'une enquê te prospective, mené e parmi des urgentologues pé diatres au Canada. La base de donné es du Groupe de Recherche en Urgence Pé diatrique du Canada pour les mé decins a servi à repé rer les sujets é ventuels, et une version modifié e de la Dillman's Total Design Survey Method a é té utilisé e aux fins de participation. Ré sultats: Le taux de ré ponse à l'enquê te a atteint 68% (139 participants sur 206). La plupart des mé decins é taient â gé s de 31 à 50 ans (82%) avaient reç u une formation en MUP (56%) et pratiquaient depuis moins de 10 ans (55%). Le dé pistage de la douleur au service des urgences (SU) se faisait presque toujours au moment du triage (97%). Vingtquatre pour cent des mé decins ont fait é tat d'une documentation obligatoire sur l'é valuation de la douleur dans leur é tablissement. L'ibuprofè ne et l'acé taminophè ne (88% et 83%, respectivement) é taient souvent prescr...

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Section: Discussionmentioning

confidence: 99%

Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

Ali

Chambers

Johnson

et al. 2014

CJEM

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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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“…During the trial period of an RCT examining oral administration of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma, no respiratory depression, or serious adverse events were reported. 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.…”

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, Controlled Trial of Acetaminophen, Ibuprofen, and Codeine for Acute Pain Relief in Children With Musculoskeletal Trauma

Abstract: For the treatment of acute traumatic musculoskeletal injuries, ibuprofen provides the best analgesia among the 3 study medications.

Cited by 180 publications

References 43 publications

Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

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

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

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