Pain Management in Children: NSAID Use in the Perioperative and Emergency Department Settings

Cooney, Maureen F.

doi:10.1007/s40272-021-00449-z

Cited by 19 publications

(10 citation statements)

References 51 publications

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“…In addition to education, the use of NSAIDs also decreased the total number of opioid doses and duration of use in the study. These findings correlate with prior literature supporting the positive effects of nonopioid medications and multimodal pain management on decreasing opioid requirements, minimizing opioid-induced adverse events, and increasing patient satisfaction 22–25 . Results from a randomized controlled trial by the Canadian Medical Association of pediatric patients having minor outpatient orthopaedic surgery found equal improvements in pain scores with no difference in efficacy between oral morphine and ibuprofen for at-home pain control 26 .…”

Section: Discussionsupporting

confidence: 83%

“…These findings correlate with prior literature supporting the positive effects of nonopioid medications and multimodal pain management on decreasing opioid requirements, minimizing opioid-induced adverse events, and increasing patient satisfaction. [22][23][24][25] Results from a randomized controlled trial by the Canadian Medical Association of pediatric patients having minor outpatient orthopaedic surgery found equal improvements in pain scores with no difference in efficacy between oral morphine and ibuprofen for at-home pain control. 26 This study also reported significant decreases in medicationrelated adverse events with the use of ibuprofen rather than morphine, again supporting the potential benefits of nonopioid medications in the 61% of patients in this study who reported opioid-associated side effects.…”

Section: Discussionmentioning

confidence: 99%

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Opioid Use in Pediatric Patients After Common Orthopaedic Surgeries

Perkins

Murata

Kim

et al. 2023

Journal of Pediatric Orthopaedics

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Background: The use and misuse of opioid medications is an epidemic and public health emergency. There are currently no standard guidelines for treating perioperative pain in the pediatric population. The purpose of this study is to describe opioid use among pediatric patients after common orthopaedic surgeries. Methods: Patients between 5 and 20 years of age undergoing one of 7 common orthopaedic surgeries between the years 2018 to 2020 were prospectively studied. Patients and their families completed a medication logbook to track all doses of pain medication and associated pain scores. Results: Three hundred forty-two patients completed the study, including 174 females and 168 males with a mean age of 14.0 years (range, 5 to 20 y). A total of 4351 tablets or liquid doses of the narcotic medication, 44% of the total prescribed, were consumed. Of the prescribed medication,56% remained unused. Nonsteroidal anti-inflammatory drug use was identified to be the only independent predictor of less narcotic use, with a mean of 5.1 tablets (P = 0.003) and 1.7 days (P < 0.01) less opioid consumed among these patients. Thirty-two (9.4%) patients consumed 100% of their prescriptions. Nonmedicinal methods of pain control, most commonly ice, were used by 77% of patients, and this was highly variable between procedures. Physicians were cited as a source of medication information by only 50% of patients, with high variability between procedures. Conclusions: Opioid medication use in children and adolescents after orthopaedic surgery is significantly less than the number of tablets prescribed, with 56% of the medication prescribed remaining unused in the postoperative period. Duration of narcotic use was longer than anticipated with a wide SD (4.7 d +/−3 d). We recommend orthopaedic surgeons responsibly prescribe pain medications using evidence-based data or the results of their own experience monitoring medication consumption. In addition, and important in the setting of the “opioid epidemic,” physicians must counsel patients and families on postoperative pain expectations and appropriate medication use. Level of Evidence: Level IV, prospective case series.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Opioid Use in Pediatric Patients After Common Orthopaedic Surgeries

Perkins

Murata

Kim

et al. 2023

Journal of Pediatric Orthopaedics

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“…According to a recent review, ketorolac was studied in children mainly for post-operative pain and administered intravenously [ 18 ]. Only a few trials investigated its employment in a PED setting.…”

Section: Discussionmentioning

confidence: 99%

Oral ibuprofen versus oral ketorolac for children with moderate and severe acute traumatic pain: a randomized comparative study

et al. 2022

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This study is to compare ibuprofen and ketorolac for children with trauma-related acute pain. We conducted a multicentre randomized, double-blind, controlled trial in the Paediatric Emergency Department setting. We enrolled patients aged 8 to 17 who accessed the emergency department for pain related to a limb trauma that occurred in the previous 48 h. At the admission, patients were classified based on numeric rating scale-11 (NRS-11) in moderate (NRS 4–6) and severe (NRS 7–10) pain groups. Each patient was randomized to receive either ibuprofen (10 mg/kg) or ketorolac (0.5 mg/kg) and the placebo of the not given drug in a double dummies design. NRS-11 was asked every 30 min until 2 h after drug and placebo administration. The primary outcome was NRS-11 reduction at 60 min. Among 125 patients with severe pain, NRS-11 reduction after 60 min from drug administration was 2.0 (IQR 1.0–4.0) for ibuprofen and 1.0 (IQR 1.0–3.0) for ketorolac (p = 0.36). Ibuprofen was significantly better, considering secondary outcomes, at 90 min with a lower median of NRS-11 (p 0.008), more patients with NRS-11 less than 4 (p 0.01) and a reduction of pain score of more than 3 NRS-11 points (p 0.01). Among 87 patients with moderate pain, the NRS-11 reduction after 60 min from drug administration was 1.63 (± 1.8) for ibuprofen and 1.8 (± 1.6) for ketorolac, with no statistically significant difference. Conclusions : Oral ibuprofen and ketorolac are similarly effective in children and adolescents with acute traumatic musculoskeletal pain. Trial registration : ClinicalTrial.gov registration number: NCT04133623. What is Known: • Limb trauma is one of the most common causes of paediatric emergency department visits. Non-steroidal anti-inflammatory drugs are the most frequently used analgesics in this clinical setting. In particular ibuprofen is the first over the counter non-steroidal anti-inflammatory drug in terms of use. Ketorolac is considered the most effective non-steroidal anti-inflammatory drug for severe pain. What is New: • This study directly compared oral ibuprofen and ketorolac for moderate and severe acute traumatic pain in children and adolescents. Both drugs were similarly effective in children and adolescents with severe pain, and ketorolac was not superior to Ibuprofen for moderate pain.

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“…According to a recent review, ketorolac was studied in children mainly for post-operative pain and administered intravenously [19]. Only a few trials investigated its employment in a PED setting.…”

Section: Discussionmentioning

confidence: 99%

Oral ibuprofen versus oral ketorolac for children with moderate and severe acute traumatic pain: a randomized comparative study

Ghirardo

Trevisan

Ronfani

et al. 2022

Preprint

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Purpose: Compare ibuprofen and ketorolac for children with trauma-related acute pain. Methods: We conducted a multicentre randomized, double-blind, controlled trial in the Paediatric Emergency Department setting. We enrolled patients aged 8 to 17 who accessed the emergency department for pain related to a limb trauma that occurred in the previous 48 hours. At the admission, patients were classified based on numeric rating scale-11 (NRS-11) in moderate (NRS 4-6) and severe (NRS 7-10) pain groups. Each patient was randomized to receive either ibuprofen (10 mg/kg) or ketorolac (0.5 mg/kg) and the placebo of the not given drug in a double dummies design. NRS-11 was asked every 30 minutes until 2 hours after drug and placebo administration. The primary outcome was NRS-11 reduction at 60 minutes. Results: Among 125 patients with severe pain, NRS-11 reduction after 60 minutes from drug administration was 2.0 (IQR 1.0-4.0) for ibuprofen and 1.0 (IQR 1.0-3.0) for ketorolac (p=0.36). Ibuprofen was significantly better, considering secondary outcomes, at 90 minutes with a lower median of NRS-11 (p 0.008), more patients with NRS-11 less than 4 (p 0.01) and a reduction of pain score of more than 3 NRS-11 points (p 0.01). Among 87 patients with moderate pain, the NRS-11 reduction after 60 minutes from drug administration was 1.63 (±1.8) for ibuprofen and 1.8 (±1.6) for ketorolac, with no statistically significant difference. Conclusions: Oral ibuprofen and ketorolac are similarly effective in children and adolescents with acute traumatic musculoskeletal pain. ClinicalTrial.gov registration number: NCT04133623

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Pain Management in Children: NSAID Use in the Perioperative and Emergency Department Settings

Cited by 19 publications

References 51 publications

Opioid Use in Pediatric Patients After Common Orthopaedic Surgeries

Opioid Use in Pediatric Patients After Common Orthopaedic Surgeries

Oral ibuprofen versus oral ketorolac for children with moderate and severe acute traumatic pain: a randomized comparative study

Oral ibuprofen versus oral ketorolac for children with moderate and severe acute traumatic pain: a randomized comparative study

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