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Evaluation of Hydrocodone/Acetaminophen for Pediatric Laceration Repair: A Randomized Trial
Corrie E Chumpitazi1, A Chantal Caviness1, Glenda H Grawe1
1From the Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine.
Insights
Hydrocodone/acetaminophen elixir effectively reduced pain in young children undergoing laceration repair. However, it did not significantly impact pain or anxiety in older children, indicating age-specific efficacy for this intervention.
Area of Science:
- Pediatric Emergency Medicine
- Pain Management
- Pharmacology
Background:
- Laceration repair in children often causes significant pain and distress.
- Effective pain management strategies are crucial in pediatric emergency care.
Purpose of the Study:
- To evaluate the efficacy of hydrocodone/acetaminophen elixir in alleviating pain and anxiety during sutured laceration repair in children.
- To determine if the medication's effects differ based on age.
Main Methods:
- A randomized, double-blinded, placebo-controlled trial was conducted.
- Participants included children aged 2 to 17 years with lacerations requiring repair.
- Pain and anxiety scores were primary and secondary outcomes, with stratification by age (<8 years and 8-17 years).
Main Results:
- Children aged 2 to 7 years showed significantly lower pain scores with hydrocodone/acetaminophen compared to placebo (p=0.01).
- No significant difference in pain or anxiety scores was observed in children aged 8 to 17 years.
- Fewer younger children in the medication group required procedural sedation.
Conclusions:
- Oral hydrocodone/acetaminophen is beneficial for reducing pain in younger children (2-7 years) undergoing laceration repair.
- The medication did not demonstrate effectiveness in reducing pain or anxiety in older children (8-17 years).
- Age is a critical factor in the efficacy of hydrocodone/acetaminophen for procedural pain in children.
Background:
Laceration repair is a common procedure, and causes pain and distress in children. The purpose of this study was to measure the effect of hydrocodone/acetaminophen elixir in reducing both pain and anxiety in children undergoing sutured laceration repair in the emergency department.
Methods:
The authors conducted a randomized, double-blinded, placebo-controlled trial in children aged 2 to 17 years, stratified by age younger than 8 years, with topical lidocaine-treated lacerations requiring sutured repair in the emergency department. The primary outcome was pain score at 5 minutes of laceration repair. Secondary outcomes included progression to procedural sedation and anxiety scores in older children.
Results:
Eighty-five children were randomized, 43 to the hydrocodone/acetaminophen group and 42 to the placebo group. Median 5-minute pain scores in children aged 2 to 7 years were significantly lower in the medication group (5.0; interquartile range, 4.0 to 6.50) compared with the placebo group (7.0; interquartile range, 5.25 to 10.0; p = 0.01). Three patients (12 percent) in the placebo group proceeded to procedural sedation. For children aged 8 to 17 years, there was no significant difference in pain scores between the treatment (0.5; interquartile range, 0.0 to 0.1; p = 0.81) and placebo groups (0.1; interquartile range, 0.01 to 0.4) or in anxiety scores using the State-Trait Anxiety Inventory for Children.
Conclusion:
Adjuvant oral hydrocodone/acetaminophen is more effective than placebo in reducing pain in children younger than 8 years undergoing topical lidocaine-treated laceration repair, but it does not decrease pain or anxiety in older children.
Clinical Question/Level Of Evidence:
Therapeutic, II.
