Ibuprofen proved just as effective as morphine for pain control in children with uncomplicated fractures, and it brought on significantly fewer adverse effects, according to a study published online October 27 in the Canadian Medical Association Journal.
In a parallel-group, randomized, blinded superiority trial, Naveen Poonai, MD, from the Division of Emergency Medicine, London Health Sciences Centre, and the Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada, and colleagues assigned 134 children treated for fracture in the emergency department of Children's Hospital in London to one of two treatment groups. The children, aged 5 through 17 years, received either four doses of normal-release morphine (0.5 mg/kg, maximum 10 mg) or four doses of ibuprofen (10 mg/kg, maximum 600 mg) every 6 hours, as needed, for 24 hours after discharge. The researchers compared pain scores, using the Faces Pain Scale–Revised, both immediately before each dose and again 30 minutes after.
The authors recorded no significant difference in pain scores between the two drugs for any of the four doses (P = .6). At dose 1, the pain score fell after morphine administration by 1.5, with a standard deviation of ±1.2, and the pain score after ibuprofen fell by 1.3 ± 1.0, for a between-group difference of 0.2 (95% confidence interval [CI], −02 to 0.6). For dose 2, the pain score fell with morphine by 1.3 ± 1.3, and for ibuprofen, it fell by 1.3 ± 0.9, for a between-group difference of 0 (95% CI, −0.4 to 0.4). At dose 3, the pain score with morphine fell by 1.3 ± 1.4, and for ibuprofen, the pain score fell by 1.4 ± 1.1, for a between-group difference of −0.1 (95% CI, −0.7 to 0.4). For the final dose, the pain score for morphine fell by 1.5 ± 1.4, whereas for ibuprofen it fell by 1.1 ± 1.2, for a between-group difference of 0.4 (95% CI, −0.2 to 1.1).
The 66 children in the morphine group had significantly more adverse events, including nausea, vomiting, and drowsiness, compared with the 68 participants in the ibuprofen group (56.1% vs 30.9%; P < .01).
The new findings confirm results from earlier studies that looked at the efficacy of ibuprofen for pain relief in children with orthopedic injury. It has been found to be more effective than either acetaminophen or codeine, and equivalent to acetaminophen-codeine combinations and to oxycodone, the researchers note. In addition, in a study involving fractures, ibuprofen was associated with less impairment than acetaminophen plus codeine, and was also more tolerable.
"Given that morphine was associated with significantly more adverse effects, we conclude that ibuprofen remains a safe and effective therapy for outpatient management of children's fracture pain," the authors write. "We hope that our results will provide clinicians with a foundation for rational analgesic choices for children with fractures who are discharged from the emergency department."
This study is funded from a Schulich Research Opportunities Grant from Western University. The authors have disclosed no relevant financial relationships.
CMAJ. Published online October 27, 2014.
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