Highlights
- •Ibuprofen and Acetaminophen are two most commonly used analgesics in the pediatric ED.
- •The multimodal pain management of using a combination of ibuprofen and acetaminophen has the potential to result in greater analgesia.
- •Randomized, double-blind superiority trial comparing analgesic efficacy of a combination of oral ibuprofen (10 mg/kg dose)/acetaminophen (15 mg/kg per dose) to either analgesic alone for treatment of pain in the pediatric ED.
- •Combination of oral ibuprofen/acetaminophen is not superior to each analgesic alone for short-term treatment of acute pain in pediatric ED.
Abstract
Background
Ibuprofen (Motrin; Johnson & Johnson) and acetaminophen (APAP, paracetamol) are the
most commonly used analgesics in the pediatric emergency department (ED) for managing
a variety of acute traumatic and nontraumatic painful conditions. The multimodal pain
management of using a combination of ibuprofen plus acetaminophen has the potential
to result in greater analgesia.
Objective
We compared the analgesic efficacy of a combination of oral ibuprofen plus acetaminophen
with either analgesic alone for pediatric ED patients with acute pain.
Methods
We performed a randomized, double-blind superiority trial assessing and comparing
the analgesic efficacy of a combination of oral ibuprofen (10 mg/kg dose) plus acetaminophen
(15 mg/kg per dose) to either analgesic alone for the treatment of acute traumatic
and nontraumatic pain in the pediatric ED. Primary outcomes included a difference
in pain scores among the three groups at 60 min.
Results
We enrolled 90 patients (30 per group). The difference in mean pain scores at 60 min
between acetaminophen and combination groups was 0.30 (95% confidence interval [CI]
−0.84 to 1.83); between ibuprofen and combination groups was −0.33 (95% CI −1.47 to
0.80); and between acetaminophen and ibuprofen groups was 0.63 (95% CI −0.54 to 1.81).
Reductions in pain scores from baseline to 60 min were similar for all patients in
each of the three groups. No adverse events occurred in any group.
Conclusions
We found similar analgesic efficacy of oral ibuprofen and acetaminophen in comparison
with each analgesic alone for short-term treatment of acute pain in the pediatric
ED, but the trial was underpowered to demonstrate the analgesic superiority of the
combination of oral ibuprofen plus acetaminophen in comparison with each analgesic
alone.
Keywords
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Article info
Publication history
Published online: April 01, 2020
Accepted:
February 15,
2020
Received in revised form:
January 22,
2020
Received:
October 7,
2019
Footnotes
Presented at NYACEP 2019, Bolton Landing, New York.
ClinicalTrials.gov ID: NCT03088800.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
