Among children who have undergone minor outpatient orthopedic surgery, ibuprofen provides equivalent postoperative pain relief compared with oral morphine, according to the results of a study published in the Canadian Medical Association Journal.

In a randomized controlled trial, children received ≤8 doses of oral morphine 0.5 mg/kg (n=77; mean age, 12.7±3.6 years), or ibuprofen 10 mg/kg (n=77; mean age, 12.1±3.5 years) every 6 hours after minor outpatient orthopedic surgery. Researchers evaluated changes in pain score after the first dose with the Faces Pain Scale – Revised as the primary outcome.

Additional analgesic requirements, adverse effects, unplanned healthcare visits, and pain scores following doses 2 through 8 were evaluated as secondary outcomes.

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Following the first treatment, pain scores were not significantly different between the ibuprofen and morphine groups (P =.2), and no significant differences in pain scores over time were observed (P =.4). No differences were noted in the rate of acetaminophen use (P =.2), and among patients who used acetaminophen, no significant difference between groups was noted in the number of acetaminophen doses used (P =.09).

The rate of adverse events was significantly higher in the morphine group compared with the ibuprofen group (69% vs 39%; P <.001). The most common adverse events included nausea (46% vs 19% for morphine vs ibuprofen; P =.002), vomiting (18% vs 4%; P =.01), and drowsiness (48% vs 22%; P =.003).

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In an interview with Clinical Pain Advisor, Naveen Poonai, MD, associate professor of Paediatrics & Internal Medicine at the Shulich School of Medicine & Dentistry, London, Ontario, Canada, and lead author on the study, noted that “for children in mild to moderate pain following outpatient surgery, ibuprofen is effective for reducing pain with fewer side effects than oral morphine.” Neither treatment completely reduces pain, suggesting that future studies would be needed to determine “to what degree combination analgesics or the addition of nonpharmacologic agents are beneficial,” he added.

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Poonai N, Datoo N, Ali S, et al. Oral morphine versus ibuprofen administered at home for postoperative orthopedic pain in children: a randomized controlled trial. CMAJ. 2017;189(40):E1252-E1258.