Oral morphine versus ibuprofen administered at home for postoperative orthopedic pain in children: a randomized controlled trial

Poonai, Naveen; Datoo, Natasha; Ali, Samina; Cashin, Megan; Drendel, Amy L.; Zhu, Rongbo; Leporé, Natasha; Greff, Michael; Rieder, Michael J.; Bartley, Debra

doi:10.1503/cmaj.170017

Cited by 52 publications

(40 citation statements)

References 54 publications

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“…The clinical study observed a significant reduction of fentanyl utilization, without risk of complications, including post-surgery bleeding. • Children aged 1-10 years who needed tonsillectomy and/or adenoidectomy received ibuprofen or the association of paracetamol/ morphine (29). The results of the study showed similar analgesic efficacy with the advantage of no morphine induced respiratory depresa, in case of ibuprofen use.…”

Section: The Safety Profile Of Ibuprofen Administred To Childrenmentioning

confidence: 89%

Ibuprofen, a drug used in pain, inflammation and fever

Negreş¹,

Pharmacy²

2019

Ro J Pediatr

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Ibuprofen is a non-steroidal antiinflammatory drug (NSAID) derived from propionic acid, used on a large scale both in adults and children for the treatment of pain, fever and inflammation of different etiologies. Many randomized clinical trials controlled against placebo or active substances support the efficacy of ibuprofen, administered alone or in combinations, single or repeated dose, in these pathological states. Literature safety data show that ibuprofen is one of the most utilized NSAIDs owing to its efficacy and reduced adverse events profile.

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Section: The Safety Profile Of Ibuprofen Administred To Childrenmentioning

confidence: 89%

Ibuprofen, a drug used in pain, inflammation and fever

Negreş¹,

Pharmacy²

2019

Ro J Pediatr

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“…There have been 3 recent trials studying oral morphine therapy for musculoskeletal injury. [24][25][26] In 2 trials, the investigators compared oral morphine therapy to ibuprofen, alone and in combination, and found no significant difference in efficacy. 24,25 In addition, all 3 trials showed significantly more adverse effects in the morphine group than in the ibuprofen group.…”

Section: Discussionmentioning

confidence: 99%

“…[24][25][26] In 2 trials, the investigators compared oral morphine therapy to ibuprofen, alone and in combination, and found no significant difference in efficacy. 24,25 In addition, all 3 trials showed significantly more adverse effects in the morphine group than in the ibuprofen group. In contrast, physicians in our study reported that orally administered morphine was their preferred opioid for moderate and severe pain at discharge.…”

Section: Discussionmentioning

confidence: 99%

Knowledge, attitudes and practices of Canadian pediatric emergency physicians regarding short-term opioid use: a descriptive, cross-sectional survey

Fowler

Ali

Gouin

et al. 2020

cmajo

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Background: In the midst of the current opioid crisis, physicians are caught between balancing children's optimal pain management and the risks of opioid therapy. This study describes pediatric emergency physicians' practice patterns for prescribing, knowledge and attitudes regarding, and perceived barriers to and facilitators of short-term use of opioids. Methods: We created a survey tool using published methodology guidelines and distributed it from October to December 2017 to all physicians in the Pediatric Emergency Research Canada database using Dillman's tailored design method for mixed-mode surveys. We performed bivariable binomial logistic regressions to ascertain the effects of clinically significant variables (e.g., training, age, sex, degree of worry regarding severe adverse events) on use of opioids as a first-line treatment for moderate pain in the emergency department, and prescription of opioids for moderate or severe pain for at-home use in children. Results: Of the 224 physicians in the database, 136 (60.7%) completed the survey (60/111 [54.1%] women; median age 44 yr). Of the 136, 74 (54.4%) had subspecialty training. Intranasally administered fentanyl was the most commonly selected opioid for first-line treatment of moderate (47 respondents [34.6%]) and severe (82 [60.3%]) pain due to musculoskeletal injury. On a scale of 0 (not worried) to 100 (extremely worried), physicians' median score for worry regarding physical dependence was 6.0 (25th percentile 0.0, 75th percentile 16.0), for worry regarding addiction 10.0 (25th percentile 2.0, 75th percentile 20.0) and for worry regarding diversion of opioids 24.5 (25th percentile 14.0, 75th percentile 52.0). On a scale of 0 (not at all) to 100 (extremely), the median score for influence of the opioid crisis on willingness to prescribe opioids was 22.0 (25th percentile 8.0, 75th percentile 49.0). The top 3 reported barriers to prescribing opioids were parental reluctance (57 [41.9%]), lack of clear guidelines for pediatric opioid use (35 [25.7%]) and concern about adverse effects (33 [24.3%]). Binomial logistic regression did not identify any statistically significant variables affecting use of opioids in the emergency department or prescribed for use at home. Interpretation: Emergency department physicians appeared minimally concerned about physical dependence, addiction risk and the current opioid crisis when prescribing opioids to children. Evidence-based development of guidelines and protocols for use of opioids in children may improve physicians' ability to manage pain in children responsibly and adequately.

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“…Therefore, findings from this study are only applicable to the emergency department environment. For example, we do not know whether using ibuprofen+morphine at home improves pain compared with ibuprofen only (although there are data to suggest it does not4). Second, participants were chosen using very selective criteria.…”

Section: Commentarymentioning

confidence: 99%

Combining morphine and ibuprofen does not improve pain control compared with using either drug alone following musculoskeletal injury in children

Groenewald

2018

Evid Based Nurs

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Oral morphine versus ibuprofen administered at home for postoperative orthopedic pain in children: a randomized controlled trial

Abstract: BACKGROUND:Oral morphine for postoperative pain after minor pediatric surgery, while increasingly popular, is not supported by evidence. We evaluated whether oral morphine was superior to ibuprofen for at-home management of children's postoperative pain.

Cited by 52 publications

References 54 publications

Ibuprofen, a drug used in pain, inflammation and fever

Ibuprofen, a drug used in pain, inflammation and fever

Knowledge, attitudes and practices of Canadian pediatric emergency physicians regarding short-term opioid use: a descriptive, cross-sectional survey

Combining morphine and ibuprofen does not improve pain control compared with using either drug alone following musculoskeletal injury in children

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