Quantifying the intensity of adverse events with ibuprofen and oxycodone: an observational cohort study. BMJ Paediatr Open 2022 May;6(1)
Date
09/03/2022Pubmed ID
36053661Pubmed Central ID
PMC9131055DOI
10.1136/bmjpo-2022-001428Scopus ID
2-s2.0-85130882726 (requires institutional sign-in at Scopus site)Abstract
OBJECTIVE: To quantify the frequency and intensity of adverse events (AEs), commonly known as side effects, experienced by children receiving either ibuprofen or oxycodone for pain management following an acute fracture. Secondary objectives were to quantify functional outcome impairment and describe demographic and clinical characteristics associated with AEs.
DESIGN: Observational cohort study.
SETTING: Paediatric emergency department.
PATIENTS: Patients (n=240) aged 4-16 years diagnosed with an acute fracture.
INTERVENTION: Prescribed either ibuprofen (n=179) or oxycodone (n=61) for pain.
MAIN OUTCOME MEASURES: Families were called for the first 3 days after discharge to report the presence and intensity of AEs and their child's functional outcomes (ability to eat, sleep, play or attend school).
RESULTS: On day 1, children using oxycodone were more likely to report any AE (χ2 1=13.5, p<0.001), nausea (χ2 1=17.0, p<0.001), vomiting (χ2 1=11.2, p<0.001), drowsiness (χ2 1=13.7,p<0.001), constipation (χ2 1=8.9, p=0.003) and dizziness (χ2 1=19.1, p<0.001), compared with those using ibuprofen. Children receiving oxycodone reported greater severity of abdominal pain (oxycodone: mean 5.4 SD 3.1; ibuprofen mean 2.5 SD 1.4, F1 13=6.5, p=0.02) on day 1 and worse intensity of constipation (oxycodone: mean 4.9 SD 2.1; ibuprofen mean 3.2 SD 2.2, F1 33=4.5, p=0.04) over all 3 days. Use of oxycodone was associated with an increased odds of experiencing an AE on day 1 (OR=1.31 (95% CI 1.13 to 1.52)). Higher pain scores (OR=1.50 (95% CI 1.12 to 2.01)), lower extremity fracture (OR=1.25 (95% CI 1.07 to 1.47)) and undergoing ED sedation (OR=1.16 (95% CI 1.01 to 1.34)) were associated with missing school. Higher pain scores (OR=1.50 (95% CI 1.14 to 1.97)) and lower extremity fractures (OR=1.23 (95% CI 1.07 to 1.43)) were also associated with less play.
CONCLUSIONS: Oxycodone is associated with more frequent AEs overall, higher intensity gastrointestinal AEs and greater functional limitations compared with ibuprofen. Lower extremity fractures cause more functional limitations than upper extremity fractures. Clinicians should consider these differences when providing fracture pain care for children.
Author List
Ali S, Gourlay K, Yukseloglu A, Rosychuk RJ, Ortiz S, Watts R, Johnson DW, Carleton B, Le May S, Drendel ALAuthor
Amy L. Drendel DO Interim Chief, Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Analgesics, OpioidChild
Cohort Studies
Constipation
Double-Blind Method
Fractures, Bone
Humans
Ibuprofen
Oxycodone
Pain
Pain Measurement