Effectiveness of Oxycodone, Ibuprofen, or the Combination in the Initial Management of Orthopedic Injury-Related Pain in Children

Koller, Darwin M.; Myers, Amanda B.; Lorenz, Doug; Godambe, Sandip A.

doi:10.1097/pec.0b013e31814a6a39

Cited by 64 publications

(64 citation statements)

References 26 publications

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“…This finding may result either from anxiety or suboptimal analgesic potency. Similar first hour results were observed by Koller et al, 20 when they compared the effectiveness of oxycodone and ibuprofen in a comparable patient population. Nonetheless, the limited use of rescue medications suggests that both drugs, when combined with nonpharmacologic measures, provided adequate analgesia.…”

Section: Discussionsupporting

confidence: 75%

Ibuprofen Provides Analgesia Equivalent to Acetaminophen–Codeine in the Treatment of Acute Pain in Children with Extremity Injuries: A Randomized Clinical Trial

Friday¹,

Kanegaye²,

McCaslin³

et al. 2009

Academic Emergency Medicine

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Objectives: This study compared the analgesic effectiveness of acetaminophen-codeine with that of ibuprofen for children with acute traumatic extremity pain, with the hypothesis that the two medications would demonstrate equivalent reduction in pain scores in an emergency department (ED) setting.Methods: This was a randomized, double-blinded equivalence trial. Pediatric ED patients 5 to 17 years of age with acute traumatic extremity pain received acetaminophen-codeine (1 mg ⁄ kg as codeine, maximum 60 mg) or ibuprofen (10 mg ⁄ kg, maximum 400 mg). The patients provided Color Analog Scale (CAS) pain scores at baseline and at 20, 40, and 60 minutes after medication administration. The primary outcome measured was the difference in changes in pain score at 40 minutes, compared to a previously described minimal clinically significant change in pain score of 2 cm. The difference was defined as (change in ibuprofen CAS score from baseline) -(change in acetaminophen-codeine CAS score from baseline); negative values thus favor the ibuprofen group. Additional outcomes included need for rescue medication and adverse effects. Results:The 32 acetaminophen-codeine and the 34 ibuprofen recipients in our convenience sample had indistinguishable pain scores at baseline. The intergroup differences in pain score change at 20 minutes ()0.6, 95% confidence interval [CI] = )1.5 to 0.3), 40 minutes ()0.4, 95% CI = )1.4 to 0.6), and 60 minutes (0.2, 95% CI = )0.8 to 1.2) were all less than 2 cm. Adverse effects were minimal: vomiting (one patient after acetaminophen-codeine), nausea (one patient after ibuprofen), and pruritus (one after acetaminophen-codeine). The three patients in each group who received rescue medications all had radiographically demonstrated fractures or dislocations.Conclusions: This study found similar performance of acetaminophen-codeine and ibuprofen in analgesic effectiveness among ED patients aged 5-17 years with acute traumatic extremity pain. Both drugs provided measurable analgesia. Patients tolerated them well, with few treatment failures and minimal adverse effects.ACADEMIC EMERGENCY MEDICINE 2009; 16:711-716 ª

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Section: Discussionsupporting

confidence: 75%

Ibuprofen Provides Analgesia Equivalent to Acetaminophen–Codeine in the Treatment of Acute Pain in Children with Extremity Injuries: A Randomized Clinical Trial

Friday¹,

Kanegaye²,

McCaslin³

et al. 2009

Academic Emergency Medicine

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“…Studies involving both adults and children with a variety of painful conditions have shown that ibuprofen's efficacy is comparable with or superior to that of opioids. 18,28,32,33 The possibility of comparable efficacy for musculoskeletal pain between NSAIDs and opioids as drug classes is evidenced by other studies that have shown ketorolac to be superior to morphine 34 and equivalent to tramadol. 35 Given ibuprofen's and morphine's similar and inexpensive prices, in addition to these results and ours, ibuprofen should be the initial drug of choice for acutely painful musculoskeletal trauma in children.…”

Section: Discussionmentioning

confidence: 87%

“…Ibuprofen has been found to be more efficacious than either acetaminophen or codeine, 18 equivalent to an acetaminophencodeine combination 32 and equivalent to oxycodone. 33 In the only study of outpatient analgesia involving children with fractures, ibuprofen was Did not take study drugs n = 23…”

Section: Discussionmentioning

confidence: 99%

Oral administration of morphine versus ibuprofen to manage postfracture pain in children: a randomized trial

Poonai

Bhullar

Lin

et al. 2014

CMAJ

104

103

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“…Studies were published between 1991 and 2014 (median year 2007) and were conducted in the United States ( n = 7), Canada (5), France (3), Italy (3), and Germany (2) and one each in Finland, New Zealand, and the United Kingdom. Most studies did not report on sources of funding ( n = 13), one specifically reported no funding [68], seven reported grant funding [13, 19, 62, 64, 66, 69, 75, 76], and two reported funding from industry [70, 75]. …”

Section: Resultsmentioning

confidence: 99%

How Safe Are Common Analgesics for the Treatment of Acute Pain for Children? A Systematic Review

Hartling

Ali

Dryden

et al. 2016

Pain Research and Management

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Background. Fear of adverse events and occurrence of side effects are commonly cited by families and physicians as obstructive to appropriate use of pain medication in children. We examined evidence comparing the safety profiles of three groups of oral medications, acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids, to manage acute nonsurgical pain in children (<18 years) treated in ambulatory settings. Methods. A comprehensive search was performed to July 2015, including review of national data registries. Two reviewers screened articles for inclusion, assessed methodological quality, and extracted data. Risks (incidence rates) were pooled using a random effects model. Results. Forty-four studies were included; 23 reported on adverse events. Based on limited current evidence, acetaminophen, ibuprofen, and opioids have similar nausea and vomiting profiles. Opioids have the greatest risk of central nervous system adverse events. Dual therapy with a nonopioid/opioid combination resulted in a lower risk of adverse events than opioids alone. Conclusions. Ibuprofen and acetaminophen have similar reported adverse effects and notably less adverse events than opioids. Dual therapy with a nonopioid/opioid combination confers a protective effect for adverse events over opioids alone. This research highlights challenges in assessing medication safety, including lack of more detailed information in registry data, and inconsistent reporting in trials.

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Effectiveness of Oxycodone, Ibuprofen, or the Combination in the Initial Management of Orthopedic Injury-Related Pain in Children

Abstract: Oxycodone, ibuprofen, and the combination all provide effective analgesia for mild-to-moderate orthopedic injuries in children. Oxycodone or ibuprofen, alone, can be given, thereby avoiding the increase in adverse effects when given together.

Cited by 64 publications

References 26 publications

Ibuprofen Provides Analgesia Equivalent to Acetaminophen–Codeine in the Treatment of Acute Pain in Children with Extremity Injuries: A Randomized Clinical Trial

Ibuprofen Provides Analgesia Equivalent to Acetaminophen–Codeine in the Treatment of Acute Pain in Children with Extremity Injuries: A Randomized Clinical Trial

Oral administration of morphine versus ibuprofen to manage postfracture pain in children: a randomized trial

How Safe Are Common Analgesics for the Treatment of Acute Pain for Children? A Systematic Review

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