Oral morphine no more effective than ibuprofen for postfracture analgesia in children

Study Type: Therapy
OE Level of Evidence: 1
Journal Level of Evidence: N/A
Synopsis
183 paediatric patients with an extremity fracture not requiring surgery were randomized to analgesia through either oral morphine or ibuprofen. The purpose of this study was to evaluate whether oral morphine was more effective than ibuprofen for pain management over the first 24 hours after administration. Over 70% of Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Not Reported
Conflicts: None disclosed
CONTENT IS LOCKED
Why was this study needed now?
Effective analgesia in children remains an important area of research, with inadequate pain management associated with a range of possible ramifications in the paediatric setting. Despite its widespread use in managing pain, there is fear that ibuprofen alone may not provide adequate analgesia in paediatric fractures. This has raised interest in possible alternative strategies, one being oral administration of morphine. Evidence regarding its use in children, however, is limited.
What was the principal research question?
Is oral morphine more effective than ibuprofen in children for the management of acute pain in fractures not requiring surgery?
Population: 183 patients (aged 5-17) with a fracture of the extremity not requiring surgery, and presenting to the paediatric emergency department within 24h of the injury. All patients were given 15mg/kg acetaminophen (max 975mg) for breakthrough pain.
Intervention: Morphine group: Participants (n=89) were allocated 0.5mg/kg normal-release morphine (ratio-MORPHINE, Ratiopharm; max 10mg). Patients also received sham ibuprofen (administered as described below) for effective blinding due to a difference in taste and consistency. Only 66 patients experienced severe enough pain to warrant taking analgesia (Mean age: 10.7 +/- 3.3).
Comparison: Ibuprofen group: Participants (n=94) were allocated to 10mg/kg ibuprofen (Advil, Pfizer Canada; max 600mg) to be taken every 6 hours as needed for 24 hours. Patients also received sham oral morphine for effective blinding due to a difference in taste and consistency. Only 68 patients experienced severe enough pain to warrant taking analgesia (Mean age: 10.8 +/- 3.1).
Outcomes: Primary outcome was pain score on the Faces Pain Scale - Revised (FPS-R) before and 30 minutes after administering a study dose. Secondary outcomes were adverse events occurring within 72 hours of first dose, and number of acetaminophen dose taken.
Methods: RCT; Patient- and assessor-blind, Double-dummy, Prospective, Single-center
Time: Pain was evaluated for the first 24 hours after drug administration, and adverse events were monitored over the first 72 hours after administration.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.