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 ibuprofen and oral morphine in children with postoperative pain. Adverse effects, however, were much more likely with morphine. (Level of Evidence = 1b)

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, 5 to 17 years of age, 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 eight doses, given six hours apart, of 0.5 mg per kg of morphine or 10 mg per kg of 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 simultaneously 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).

Study design: Randomized controlled trial (double-blinded)

Funding source: Foundation

Allocation: Concealed

Setting: Inpatient (any location) with outpatient follow-up

Reference:PoonaiNDatooNAliSet alOral morphine versus ibuprofen administered at home for postoperative orthopedic pain in children: a randomized controlled trial. CMAJ2017;189(40):E1252–E1258.