167 Oral Morphine versus Ibuprofen for Post-Fracture Pain Management in Children: A Randomized Controlled Study

In the emergency department (ED), fractures are a common painful condition where evidence suggests that analgesia is under-utilized. Codeine has been removed from many pediatric formularies due to safety concerns and the use of a theoretically more predictable drug: oral morphine has increased. However, it has not been studied in the pain management of pediatric fractures. This study was undertaken to determine if oral morphine is superior to ibuprofen in relieving post-fracture pain without an increase in adverse effects. Children aged 5-17 years who presented to the ED with a non-operative fracture were randomized to receive either oral morphine 0.5 mg/kg (max 10 mg) or ibuprofen 10 mg/kg (max 600 mg) every 6 hours as needed for pain for 24 hours following discharge. The primary outcome variable was the pre-post intervention difference in self-reported pain scores using the Faces Pain Scale - Revised (FPS-R). A total of 131 participants were included in the analysis with a mean age + SD of 10.7 + 3.2 years. In both arms, there was a reduction in pain scores following the intervention at each dose, with no significant differences in the change in pain for any of the four doses. However, there were significantly more adverse effects reported in the oral morphine group (55.6% versus 30.9%, P=.005). Both oral morphine and ibuprofen were effective at reducing pain in children with fractures. Although there was no significant difference in analgesic efficacy between the two agents, oral morphine was associated with significantly more adverse effects.