Authors: Poonai N et al. CMAJ Oct 2017
Ibuprofen was as effective as oral morphine for treating pain in children and adolescents after outpatient minor orthopedic surgery.
The overuse of opioids for treating pain in children is a serious concern. Researchers in Canada randomized 154 children aged 5 to 17 years to oral morphine (0.5 mg/kg; maximum dose, 20 mg) or ibuprofen (10 mg/kg; maximum dose, 600 mg) every 6 hours as needed for 48 hours after outpatient minor orthopedic surgery. Pain was assessed with the Faces Pain Scale-Revised (score of 0 = no pain, 10 = maximal pain) immediately before and 30 minutes after each dose. The primary outcome was the difference between pre- and postdose scores for the first medication dose.
Overall, 13 patients did not take any medication and 12 patients took only one dose. Time to the first dose was 3.5 hours. In both the morphine and ibuprofen groups, the median predose pain score was 3 for the first three doses and 2 or less for the remaining doses. The median difference in scores before and after the first dose was 1 for both the morphine and ibuprofen groups for each of the first four doses. Use of acetaminophen for breakthrough pain was uncommon and similar in the two groups. Adverse effects were significantly more common with morphine than ibuprofen, particularly drowsiness (48% vs. 22%) and nausea (46% vs. 19%).
For treating postoperative pain after minor orthopedic surgery, ibuprofen is as effective as oral morphine, has fewer adverse effects, and is preferable. These results are similar to those from previous studies of posttonsillectomy pain (NEJM JW Pediatr Adolesc Med Mar 2015 and Pediatrics 2015; 135:307), and add further evidence that opioids are unnecessary for minor postoperative pain.