Oral administration of morphine versus ibuprofen to manage postfracture pain in children: a randomized trial
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Published on: July 29, 2014
Naveen Poonai1, Gina Bhullar2, Kangrui Lin2
1Division of Emergency Medicine (Poonai, Bhullar, Lin, Papini, Mainprize, Howard, Teefy, Bale, Langford, Lim, Stitt), London Health Sciences Centre; Department of Paediatrics (Poonai, Lim), Schulich School of Medicine and Dentistry, Western University; and Department of Paediatrics (Rieder), Children's Hospital of Western Ontario, London, Ont.; Department of Pediatrics (Ali), University of Alberta; and Women and Children's Health Research Institute (Ali), Edmonton, Alta. naveen.poonai@lhsc.on.ca.
Insights
Oral morphine and ibuprofen showed similar pain relief for children with fractures. Ibuprofen is a safer choice, causing fewer adverse effects than morphine in pediatric fracture pain management.
Area of Science:
- Pediatric Pain Management
- Pharmacology
- Orthopedic Injuries
Background:
- Health Canada warnings prompted increased use of NSAIDs and morphine for pediatric fractures.
- This study compared oral morphine and ibuprofen for fracture-related pain in children.
Purpose of the Study:
- To determine if oral morphine is more effective than ibuprofen for pediatric fracture pain.
- To compare the safety and efficacy of two common analgesics in children.
Main Methods:
- A randomized, blinded superiority trial involving children with uncomplicated extremity fractures.
- Participants received either oral morphine (0.5 mg/kg) or ibuprofen (10 mg/kg) for 24 hours post-discharge.
- Pain was assessed using the Faces Pain Scale - Revised (FPS-R) before and after medication doses.
Main Results:
- No significant difference in pain score reduction was observed between morphine and ibuprofen groups at any time point.
- Both analgesics reduced pain scores, but morphine did not demonstrate superior efficacy.
- The morphine group experienced significantly more adverse effects (56.1%) compared to the ibuprofen group (30.9%).
Conclusions:
- Oral morphine and ibuprofen exhibit comparable analgesic efficacy for uncomplicated pediatric fractures.
- Ibuprofen is a safer alternative due to a lower incidence of adverse events.
- Ibuprofen is recommended for outpatient pain management in children with fractures.
Background:
Recent warnings from Health Canada regarding codeine for children have led to increased use of nonsteroidal anti-inflammatory drugs and morphine for common injuries such as fractures. Our objective was to determine whether morphine administered orally has superior efficacy to ibuprofen in fracture-related pain.
Methods:
We used a parallel group, randomized, blinded superiority design. Children who presented to the emergency department with an uncomplicated extremity fracture were randomly assigned to receive either morphine (0.5 mg/kg orally) or ibuprofen (10 mg/kg) for 24 hours after discharge. Our primary outcome was the change in pain score using the Faces Pain Scale - Revised (FPS-R). Participants were asked to record pain scores immediately before and 30 minutes after receiving each dose.
Results:
We analyzed data from 66 participants in the morphine group and 68 participants in the ibuprofen group. For both morphine and ibuprofen, we found a reduction in pain scores (mean pre-post difference ± standard deviation for dose 1: morphine 1.5 ± 1.2, ibuprofen 1.3 ± 1.0, between-group difference [δ] 0.2 [95% confidence interval (CI) -0.2 to 0.6]; dose 2: morphine 1.3 ± 1.3, ibuprofen 1.3 ± 0.9, δ 0 [95% CI -0.4 to 0.4]; dose 3: morphine 1.3 ± 1.4, ibuprofen 1.4 ± 1.1, δ -0.1 [95% CI -0.7 to 0.4]; and dose 4: morphine 1.5 ± 1.4, ibuprofen 1.1 ± 1.2, δ 0.4 [95% CI -0.2 to 1.1]). We found no significant differences in the change in pain scores between morphine and ibuprofen between groups at any of the 4 time points (p = 0.6). Participants in the morphine group had significantly more adverse effects than those in the ibuprofen group (56.1% v. 30.9%, p < 0.01).
Interpretation:
We found no significant difference in analgesic efficacy between orally administered morphine and ibuprofen. However, morphine was associated with a significantly greater number of adverse effects. Our results suggest that ibuprofen remains safe and effective for outpatient pain management in children with uncomplicated fractures.
Trial Registration:
ClinicalTrials.gov, no. NCT01690780.
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