Ibuprofen safe, effective in children discharged home with bone fractures

In children discharged home with a fracture, both ibuprofen and oral morphine were effective at relieving pain. However, there were no significant differences in efficacy between the 2 agents and oral morphine was associated with more side effects, according to a study published in the Canadian Medical Association Journal.

Codeine, a commonly used drug, has been removed from several pediatric hospital formularies due to safety concerns.  

“This gap in options for pain therapy in children has coincided with an increasing trend in the use of oral morphine,” said lead study author Naveen Poonai, MSc, MD, pediatric emergency physician, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada. “Coupled with mounting evidence that the management of childrens' pain in the emergency department is sub-optimal, we felt this was the right time to do this study.”

In a randomized controlled trial, Dr Poonai and colleagues compared oral morphine to ibuprofen in children who came to the emergency department with a non-operative fracture using a standard method of comparing 2 therapies. They gave the participants enough medication to last them for 24 hours and told them to take it on an as-needed basis. The patients were then asked them to fill out a pain scale and return it by mail. Patients were also asked to record any side effects they experienced. 

The study showed that more than 70% of children with fractures experience pain at home.

“Currently, no standard of care exists for the provision of discharge instructions or parental education in these cases,” Dr Poonai said. “Our findings show that ibuprofen is safe and effective for post-fracture pain. Taken together, this information should behoove hospital policy-makers to ensure that health providers at all levels have ready access to education on how to advise parents on managing their child's pain at home.” 

Pain affects the vast majority of children who have sustained a fracture once they are discharged home and ibuprofen remains a good choice because it's safe and effective, according to Dr Poonai.

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