Analgesia in Children: Ibuprofen as Effective as Acetaminophen-Codeine

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Analgesia in Children: Ibuprofen as Effective as Acetaminophen-Codeine

Ibuprofen and acetaminophen-codeine provided similar relief of traumatic extremity pain in children aged 5 to 17 years.

Hesitance to use opioids is a barrier to effective treatment of pain in children. In this study, researchers randomized a convenience sample of 66 children (age range, 5–17 years) with acute traumatic extremity pain (pain scores $≥$ 5 on a 1–10 verbal numeric scale) to receive ibuprofen (10 mg/kg to a maximum dose of 400 mg) or acetaminophen-codeine (1 mg/kg as codeine to a maximum dose of 60 mg). Using the validated color analog scale, children rated their pain before administration of the study drug and 20, 40, and 60 minutes after administration. Both groups had similar and clinically significant improvement in pain scores at all time points, with minimal adverse effects.

Comment: These findings should encourage the use of ibuprofen to treat acute traumatic extremity pain in children. This study also serves as a reminder that codeine is a poor analgesic and that an effective opioid, such as hydrocodone or oxycodone, should be considered for children with moderate-to-severe pain that is not effectively relieved by ibuprofen or acetaminophen.

— Diane M. Birnbaumer, MD, FACEP

Published in Journal Watch Emergency Medicine September 18, 2009

Citation(s):

Friday JH et al. Ibuprofen provides analgesia equivalent to acetaminophen–codeine in the treatment of acute pain in children with extremity injuries: A randomized clinical trial. Acad Emerg Med 2009 Aug; 16:711.

Medline abstract (Free)

Reader Remarks:

Review and add to remarks on this article

ibuprofen vs. Tylenol with codeine in pediatric extremity injuries
Diane E Miessler, 4 Jan 2010 1:06 PM EST
I just read an article indicating that ibuprofen is just as effective as acetaminophen with codeine in pediatric extremity injuries.... [more]
Pain management - underestimating the placebo effect ... yet again.
R. Luz Coelho, Family Practice - Curitiba - Brazil, 22 Jan 2010 10:28 AM EST
Every time I see a new article on pain management in small populations without a placebo control it causes butterflies... [more]

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