London, Ontario—Ibuprofen works about as well as oral morphine in resolving pain from minor orthopedic outpatient surgery in children but causes far fewer side effects.

That’s according to a report in CMAJ (the Canadian Medical Association Journal). The clinical trial involved 154 children aged 5 to 17 years who underwent minor orthopedic surgery, including keyhole surgery on joints, ligament and tendon repair, suture or hardware removal at London Health Sciences Centre.

“This result suggests that adequate pain management should be an important goal of care, even after minor outpatient surgery, and that more effective pharmacologic and nonpharmacologic strategies should be explored,” write Western University–led study authors.

More than 80% of the children in the study needed pain relief at home within 24 hours after surgery, according to the study.

Analyzing data for 77 participants in each of the morphine and ibuprofen groups, researchers determined that both interventions decreased pain scores with no difference in efficacy. The median difference in pain score before and after the first dose of medication was 1 (interquartile range 0–1) for both morphine and ibuprofen. For the second through eighth dose, the median differences in pain score before and after also were not significantly different between groups.

At the same time, however, many more—69% versus 39%—of children taking morphine reported adverse effects compared with those using ibuprofen. Most common was drowsiness, reported by 48% of the morphine group and 22% of the ibuprofen groups, the researchers point out.

“Morphine was not superior to ibuprofen, and both drugs decreased pain with no apparent difference in efficacy,” study authors write. “Morphine was associated with significantly more adverse effects, which suggests that ibuprofen is a better first-line option after minor surgery.”

The study was touted as the first to look at oral morphine use at home in children who have had minor surgery and also the first to compare the drug to ibuprofen.

The researchers add, however, that neither treatment completely relieved pain and call for more research into effective pain relief for children who undergo surgery. 
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