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Acute pain relief from ibuprofen equivalent to paracetamol plus codeine for extremity injury in children (POEM)

POEM (Patient Oriented Evidence that Matters)

Clinical question

Is ibuprofen equivalent to paracetamol plus codeine in the treatment of acute pain in children with extremity injuries?

Bottom line

Acute pain relief from ibuprofen is equivalent to that of paracetamol plus codeine for children presenting to emergency departments with extremity injury. More than half the children in this study were consequently found to have fractures.

Synopsis

A previous study reported better pain control from ibuprofen than paracetamol or codeine in the treatment of acute pain in children with extremity injuries (Pediatrics 2007;119:460–7). These investigators identified 68 children, aged five to 17 years, presenting to emergency departments with acute traumatic extremity injury.

Eligible patients randomly received (allocation concealed) either paracetamol plus codeine (1mg/kg as codeine, maximum 60mg) or ibuprofen (10mg/kg, maximum 400mg). Patients, parents and treating clinicians remained masked to treatment group assignment. All patients also received splints and ice packs as needed before undergoing radiography. Complete follow-up occurred for all patients until discharge from the emergency department.

Pain scores were assessed at baseline and after analgesia using a previously validated standard tool for acute pain in paediatric patients. Radiography demonstrated fractures in 55 per cent of the patients. Using intention-to-treat analysis, pain relief (change in pain scores at 10, 40, and 60 minutes compared with baseline) was similar in both groups.

Both parents and clinicians were unable to guess treatment group assignment significantly correctly. Adverse events were minimal and occurred similarly in both groups. The study was 90 per cent powered to detect a clinically important difference in pain scores.

Level of evidence

1b (individual randomised control trial with narrow confidence interval).

Reference

Friday JH, Kanegaye JT, McCaslin I, Zheng A, Harley JR. Ibuprofen provides analgesia equivalent to acetaminophen-codeine in the treatment of acute pain in children with extremity injuries: a randomized clinical trial. Academic Emergency Medicine 2009;16(8):711–6.

Funding Unknown/not stated

POEM (Patient Oriented Evidence that Matters) © 1995-2009 John Wiley &Sons, Inc. or related companies. All Rights reserved. www.essentialevidenceplus.com

Citation: The Pharmaceutical Journal URI: 10978566

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