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Ibuprofen and morphine provide similar post-op pain relief in kids; ibuprofen has fewer harms
Clinical Question
Which is the better oral pain reliever for children with postoperative pain: ibuprofen or morphine?
Bottom line
This carefully designed and adequately powered study found no difference in pain reduction between ibuproften and oral morphine in children with postoperative pain. Adverse effects, however, were much more likely with morphine. 1b
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Foundation
Setting: Inpatient (any location) with outpatient follow-up
Synopsis
As concern increases about overly broad uses of opiates, it is good to see studies that evaluate their effectiveness in different populations. This study identified 154 children, aged 5 years to 17 years, who underwent an outpatient orthopedic surgical procedure (most commonly hardware removal, open reduction and internal fixation of a fracture, or arthroscopy). The patients were randomized to receive up to 8 doses, given 6 hours apart, of either 0.5 mg/kg morphine or 10 mg/kg ibuprofen. Pain was assessed by the patient immediately before and 30 minutes after each dose of medication using the well validated 10-point FACES scale; a difference of at least 1 point on this scale is considered to be clinically meaningful. Medication was given using a "double-dummy" design, so each patient simulataneously got one active medication and one placebo. Groups were similar at baseline and analysis was by intention to treat. Both medications reduced pain by approximately 1 point at each dose, with no difference between groups in efficacy. There was a significantly greater risk of adverse events in the morphine group, primarily nausea, vomiting, drowsiness, and dizziness (number needed to treat to harm for any adverse event = 3).
Reviewer
Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA
Comments
bad poem
good poem
Il est bon de voir que l’ibuprofen est efficace pour divers opérations orthopédiques. Il serait intéressant de voir si l’effi Se maintient pour des opérations intrabdominales.
This study mention that pain relief was one point I wonder if that was adequate , I wonder if Morphine or Ibuprofen was used in adequate doses and if there was adequate pain relief.
Important to remember post op Orthopedics pain
May be different in other types of piston pain
30 minutes after dosing may be too short to assess peak effect of either oral medication.
Updates my own experience as it may be sought regarding grand children for instance
Ideal almost exclusively with severe chronic pain and I rarely if ever have to prescribe anything stronger than a tramacet or a Tylenol number three, in very small amounts for a very short time. I can't imagine why physicians rely on narcotics instead of properly examining their patients and treating the problem causing the pain.
It would be interesting to know if similar results would be seen in an adult population. Using ibuprofen instead of morphine post-op would reduce population exposure to opioid medications, and may lead to a reduction in numbers of "accidental addicts" (who start with prescribed opioids), and/or relapse in those with an opioid use disorder history.
Opiates the worst scourge of modern medical care. So very sad. Maybe, research like this can put things in perspective.