Abstract
To compare the effectiveness and safety of prescribing ibuprofen and oxycodone for at-home management of children's fracture pain. A prospective observational cohort was conducted at the Stollery Children's Hospital pediatric emergency department (June 2010-July 2014). Children aged 4-16 years with an isolated fracture discharged home with advice to use either ibuprofen or oxycodone were recruited. A cohort of 329 children (n = 217 ibuprofen, n = 112 oxycodone) were included. Mean age was 11.1 years (SD 3.5); 68% (223/329) were male. Fracture distribution included 80.5% (264/329) upper limb with 34.3% (113/329) requiring fracture reduction. The mean reduction in Faces Pain Score-Revised score (maximum pain-post-treatment pain) for Day 1 was 3.6 (SD 1.9) (ibuprofen) and 3.8 (SD 2.1) (oxycodone) (p = 0.50); Day 2 was 3.6 (SD 1.8) (ibuprofen) and 3.7 (SD 1.6) (oxycodone) (p = 0.56); Day 3 was 3.7 (SD 1.7) (ibuprofen) and 3.3 (SD 1.7) (oxycodone) (p = 0.24). Children prescribed ibuprofen (51.2%, 109/213) experienced less adverse events compared to those prescribed oxycodone (70.5% 79/112) on Day 1 (p = 0.001). Children prescribed ibuprofen (71.8%, 150/209) had their function (eat, play, school, sleep) affected less than those prescribed oxycodone (83.0%, 93/112) (p = 0.03) on Day 1. Children prescribed ibuprofen or oxycodone experienced similar analgesic effectiveness for at-home fracture pain. Oxycodone prescribing was associated with more adverse events and negatively impacted function. Oxycodone use does not appear to confer any benefit over ibuprofen for pain relief and has a negative adverse effect profile. Ibuprofen appears to be a safe option for fracture-related pain.
Highlights
Pain is among the most common reasons for seeking healthcare and choosing appropriate pain medication is critical [1,2,3]
Oxycodone prescribing was associated with more adverse events and negatively impacted function
On Day 1, a total of 19% (41/213) of the ibuprofen group used other medication(s) for pain treatment compared to 42% (47/112) in the oxycodone group (p < 0.001)
Summary
Pain is among the most common reasons for seeking healthcare and choosing appropriate pain medication is critical [1,2,3]. Opioids are commonly used for moderate to severe traumatic pain in children, but this practice has come under recent scrutiny, in light of the current opioid crisis and concerns of misuse potential after short-term use [17,18,19,20]. While oral morphine has been shown to have similar effectiveness as oral ibuprofen for fracture-related pain management [21,22,23,24], oxycodone has not been studied to the same extent. Our study objectives were to describe the at-home clinical effectiveness and safety of ibuprofen and oxycodone when they are recommended for use and determine effects on short-term functioning for children discharged home from the emergency department (ED) with a limb fracture
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