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Effectiveness of Oxycodone, Ibuprofen, or the Combination in the Initial Management of Orthopedic Injury-Related Pain in Children

Koller, Darwin M. MD, MSCE*; Myers, Amanda B. MD, MSPH*; Lorenz, Doug MA; Godambe, Sandip A. MD, PhD*‡

doi: 10.1097/PEC.0b013e31814a6a39
Original Articles

Objective: Orthopedic injuries comprise a majority of the indications for analgesia in the emergency department. Oxycodone and ibuprofen have demonstrated efficacy for this indication, but no studies have compared these drugs in children. Our objective was to investigate the effectiveness of oxycodone, ibuprofen, or their combination for the management of orthopedic injury-related pain in children.

Methods: This prospective, randomized, double-blinded, clinical trial compared the effectiveness of oxycodone, ibuprofen, and the combination in children (age, 6-18 years), with pain from a suspected orthopedic injury. Subjects were block-randomized to receive 1 of the 3 treatment regimens. Pain was assessed with the Faces Pain Scale (FPS) and Visual Analog Scale at baseline, postimmobilization, 30, 60, 90, and 120 minutes postmedication. The change in the FPS score over time was compared between the 3 treatment groups using a generalized estimating equation model.

Results: Although all 3 treatment groups demonstrated a decrease in the FPS score over time, there were no significant differences between the groups. Among the 66 total children enrolled in the 3 treatment groups, there were no statistically significant differences in demographics or injury characteristics. There were 28 subjects with fractures. Immobilization of the injury demonstrated a significant reduction in the FPS score. Subjects in the combination treatment group reported more adverse effects.

Conclusions: Oxycodone, ibuprofen, and the combination all provide effective analgesia for mild-to-moderate orthopedic injuries in children. Oxycodone or ibuprofen, alone, can be given, thereby avoiding the increase in adverse effects when given together.

*Division of Pediatric Emergency Medicine, Departments of Pediatrics, †Bioinformatics and Biostatistics, University of Louisville, Louisville, KY and ‡Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN.

Supported in part by a grant from the University of Louisville Pediatrics Foundation, Department of Pediatrics, School of Medicine, University of Louisville, Louisville, KY.

Address correspondence and reprint requests to Darwin Koller, MD, MSCE, Division of Pediatric Emergency Medicine, University of Tennessee Chattanooga, T.C. Thompson Children's Hospital, 910 Blackford St, Chattanooga, TN 37403-1405. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.