PT  - JOURNAL ARTICLE
AU  - Poonai, Naveen
AU  - Bhullar, Gina
AU  - Lin, Kangrui
AU  - Papini, Adam
AU  - Mainprize, David
AU  - Howard, Jocelyn
AU  - Teefy, John
AU  - Bale, Michelle
AU  - Langford, Cindy
AU  - Lim, Rodrick
AU  - Stitt, Larry
AU  - Rieder, Michael J.
AU  - Ali, Samina
TI  - Oral administration of morphine versus ibuprofen to manage postfracture pain in children: a randomized trial
AID  - 10.1503/cmaj.140907
DP  - 2014 Dec 09
TA  - Canadian Medical Association Journal
PG  - 1358--1363
VI  - 186
IP  - 18
4099  - http://www.cmaj.ca/content/186/18/1358.short
4100  - http://www.cmaj.ca/content/186/18/1358.full
SO  - CMAJ2014 Dec 09; 186
AB  - Background: Recent warnings from Health Canada regarding codeine for children have led to increased use of nonsteroidal anti-inflammatory drugs and morphine for common injuries such as fractures. Our objective was to determine whether morphine administered orally has superior efficacy to ibuprofen in fracture-related pain.Methods: We used a parallel group, randomized, blinded superiority design. Children who presented to the emergency department with an uncomplicated extremity fracture were randomly assigned to receive either morphine (0.5 mg/kg orally) or ibuprofen (10 mg/kg) for 24 hours after discharge. Our primary outcome was the change in pain score using the Faces Pain Scale — Revised (FPS-R). Participants were asked to record pain scores immediately before and 30 minutes after receiving each dose.Results: We analyzed data from 66 participants in the morphine group and 68 participants in the ibuprofen group. For both morphine and ibuprofen, we found a reduction in pain scores (mean pre–post difference ± standard deviation for dose 1: morphine 1.5 ± 1.2, ibuprofen 1.3 ± 1.0, between-group difference [δ] 0.2 [95% confidence interval (CI) −0.2 to 0.6]; dose 2: morphine 1.3 ± 1.3, ibuprofen 1.3 ± 0.9, δ 0 [95% CI −0.4 to 0.4]; dose 3: morphine 1.3 ± 1.4, ibuprofen 1.4 ± 1.1, δ −0.1 [95% CI −0.7 to 0.4]; and dose 4: morphine 1.5 ± 1.4, ibuprofen 1.1 ± 1.2, δ 0.4 [95% CI −0.2 to 1.1]). We found no significant differences in the change in pain scores between morphine and ibuprofen between groups at any of the 4 time points (p = 0.6). Participants in the morphine group had significantly more adverse effects than those in the ibuprofen group (56.1% v. 30.9%, p < 0.01).Interpretation: We found no significant difference in analgesic efficacy between orally administered morphine and ibuprofen. However, morphine was associated with a significantly greater number of adverse effects. Our results suggest that ibuprofen remains safe and effective for outpatient pain management in children with uncomplicated fractures. Trial registration: ClinicalTrials.gov, no. NCT01690780.