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Am Fam Physician. 2010;81(4):531-532

Background: Ibuprofen and acetaminophen with codeine are commonly used to treat fracture pain in children, although their relative effectiveness is unclear. Earlier studies have found ibuprofen to be the more effective agent for controlling musculoskeletal pain in children, and for controlling postoperative orthopedic pain in adults. Drendel and colleagues conducted a double-blind trial among children with arm fractures to determine whether ibuprofen or acetaminophen with codeine is more effective for pain management.

The Study: Children four to 18 years of age with a closed fracture of the radius, ulna, or humerus that occurred within the previous 12 hours were evaluated. Patients were randomized to receive a suspension of ibuprofen (10 mg per kg per dose) or acetaminophen with codeine (120 mg per 5 mg per 5 mL, with a codeine component of 1 mg per kg per dose). Parents were instructed to give the study medication every four to six hours as needed for pain, with a maximum of four doses in a 24-hour period. An alternative medication was allowed if pain relief was inadequate with the study medication alone. Children were excluded for related allergies, developmental delay, an increased risk of bleeding (e.g., bleeding disorders, gastrointestinal ulcers), kidney disease, or if they had an open fracture or a fracture requiring reduction.

Results: The 244 children enrolled in the study had an average age of eight years and similar baseline traits, including fracture type and initial pain scores. Subsequent pain scores remained similar between the groups, with each group using a median of four doses of study medication during the next three days. No statistically significant difference was noted between groups in treatment failures requiring the use of the alternative medication.

The ibuprofen group had less impairment during play and eating than did the acetaminophen with codeine group. More parents of children receiving ibuprofen were satisfied with the study medication (86 versus 67 percent of those in the acetaminophen with codeine group). More children receiving acetaminophen with codeine said they would not use that medication again, compared with those receiving ibuprofen (27.5 versus 10.0 percent, respectively).

Conclusion: The authors conclude that ibuprofen is at least as effective as acetaminophen with codeine for pain relief in children with arm fractures not requiring reduction. In this study, both children and parents were more satisfied with ibuprofen.

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