A randomized, controlled trial of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma
Child; Female; Humans; Male; Pain Measurement; Analgesics; Treatment Outcome; Patient Satisfaction; Acute Disease; adolescent; Administration; Oral; Non-Narcotic/therapeutic use; Dose-Response Relationship; Drug; Opioid/therapeutic use; Pain/diagnosis/drug therapy/etiology; Codeine/therapeutic use; Acetaminophen/therapeutic use; Ibuprofen/therapeutic use; Wounds and Injuries/complications
OBJECTIVE: Our goal was to determine which of 3 analgesics, acetaminophen, ibuprofen, or codeine, given as a single dose, provides the most efficacious analgesia for children presenting to the emergency department with pain from acute musculoskeletal injuries. PATIENTS AND METHODS: Children 6 to 17 years old with pain from a musculoskeletal injury (to extremities, neck, and back) that occurred in the preceding 48 hours before presentation in the emergency department were randomly assigned to receive orally 15 mg/kg acetaminophen, 10 mg/kg ibuprofen, or 1 mg/kg codeine. Children, parents, and the research assistants were blinded to group assignment. The primary outcome was change in pain from baseline to 60 minutes after treatment with study medication as measured by using a visual analog scale. RESULTS: A total of 336 patients were randomly assigned, and 300 were included in the analysis of the primary outcome (100 in the acetaminophen group, 100 in the ibuprofen group, and 100 in the codeine group). Study groups were similar in age, gender, final diagnosis, previous analgesic given, and baseline pain score. Patients in the ibuprofen group had a significantly greater improvement in pain score (mean decrease: 24 mm) than those in the codeine (mean decrease: 11 mm) and acetaminophen (mean decrease: 12 mm) groups at 60 minutes. In addition, at 60 minutes more patients in the ibuprofen group achieved adequate analgesia (as defined by a visual analog scale <30 mm) than the other 2 groups. There was no significant difference between patients in the codeine and acetaminophen groups in the change in pain score at any time period or in the number of patients achieving adequate analgesia. CONCLUSIONS: For the treatment of acute traumatic musculoskeletal injuries, ibuprofen provides the best analgesia among the 3 study medications.
2007
Clark E; Plint AC; Correll R; Gaboury I; Passi B
Pediatrics
2007
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1542/peds.2006-1347" target="_blank" rel="noreferrer">10.1542/peds.2006-1347</a>
Acetaminophen toxicity in children
Child; Humans; Pediatrics; Adult; Analgesics; Age Factors; Acetaminophen/adverse effects/poisoning/therapeutic use; Charcoal/therapeutic use; Ibuprofen/therapeutic use; Non-Narcotic/adverse effects/poisoning/therapeutic use; Overdose/diagnosis/therapy
Acetaminophen is widely used in children, because its safety and efficacy are well established. Although the risk of developing toxic reactions to acetaminophen appears to be lower in children than in adults, such reactions occur in pediatric patients from intentional overdoses. Less frequently, acetaminophen toxicity is attributable to unintended inappropriate dosing or the failure to recognize children at increased risk in whom standard acetaminophen doses have been administered. Because the symptoms of acetaminophen intoxication are nonspecific, the diagnosis and treatment of acetaminophen intoxication are more likely to be delayed in unintentional cases of toxicity. This statement describes situations and conditions that may contribute to acetaminophen toxicity not associated with suicidal intentions.
2001
American Academy of PediatricsCommittee on Drugs
Pediatrics
2001
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1542/peds.108.4.1020" target="_blank" rel="noreferrer">10.1542/peds.108.4.1020</a>