Ibuprofen Versus Codeine. Is One Better for Post-operative Pain Relief Following Reduction of Paediatric Forearm Fractures?
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Purpose
For simple fractures treated in the emergency department with cast immobilisation only, ibuprofen has been shown to be superior to, or a least or equivalent to codeine with less side effects. These and other studies have commented that their results may not be applicable to children who have fractures that require reduction. There is currently no literature on the management of postoperative pain following reduction of paediatric fractures. The investigators aim therefore is to investigate whether either of the two most commonly prescribed analgesics is superior to the other for postoperative pain management following closed reductions of paediatric forearm fractures. Also, if one agent has more side effects than the other.
| Condition | Intervention |
|---|---|
|
Fracture Pain |
Drug: Acetaminophen and Ibuprofen Drug: Acetaminophen and Codeine |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Single Group Assignment Masking: Single Blind (Subject) Primary Purpose: Treatment |
| Official Title: | Ibuprofen vs. Codeine. Is One Better for Post-operative Pain Relief Following Reduction of Paediatric Forearm Fractures? |
- Pain Diary [ Time Frame: Two Weeks ] [ Designated as safety issue: Yes ]
Caregivers, or the children if old enough, will be asked to keep a pain diary. This will consist of the times the analgesia was taken and a pain score at awakening, at bedtime and before and 1 hour after each dose of medication.
Caregivers/children will also be asked to include any side effects noted to medication and whether play, school, sleep, and eating are affected by pain each day. Caregivers will record whether the function was increased, decreased, or unchanged.
- Patient Satisfaction [ Time Frame: 2 weeks ] [ Designated as safety issue: No ]Parent satisfaction will be measured each day with the use of a Likert 0-5 scale.
| Estimated Enrollment: | 50 |
| Study Start Date: | July 2012 |
| Estimated Study Completion Date: | August 2014 |
| Estimated Primary Completion Date: | December 2013 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Active Comparator: Acetaminophen and Codeine
After their fracture is reduced, these patients will receive acetaminophen (15mg/kg) and codeine (1mg/kg) at regular dosing intervals.
|
Drug: Acetaminophen and Codeine
After their fracture is reduced, these patients will receive acetaminophen (15mg/kg) and codeine (1mg/kg) at regular dosing intervals.
|
|
Active Comparator: Acetaminophen and Ibuprofen
Following reduction of their fracture, these patients will receive acetaminophen (15mg/ml) and ibuprofen (10mg/ml) at regular dosing intervals.
|
Drug: Acetaminophen and Ibuprofen
After their fracture is reduced, these patients will receive acetaminophen (15mg/kg) and ibuprofen (10mg/kg) at regular dosing intervals.
Other Name: Ibuprofen (Advil)
|
Detailed Description:
This will be a prospective randomised controlled trial with the null hypothesis that there is no difference between ibuprofen and codeine in terms of pain relief or side effects.
Following ethics approval (submitted and approved) by the University of Manitoba ethics board a study group of fifty patients (25 in each arm) will be recruited to participate in the study.All patients will complete informed consent following both a verbal and written explanation of the study. Following the closed reduction they will all receive regular acetaminophen; (dose 15mg/kg) and either ibuprofen (10mg/kg) or codeine (1mg/kg) depending upon the group they were randomised to. This will have to be single blinding as the codeine formulation used by the hospital is a clear red liquid (5mg/ml) and the ibuprofen a cloudy colourless liquid (20mg/ml). They will also be given a "rescue" medication to be taken if the caregivers feel that the pain relief is not sufficient 1 hour after the study medication. This rescue medication will be the alternative medication in the study.
Eligibility| Ages Eligible for Study: | 3 Years to 16 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- All paediatric patients presenting to the section of paediatric orthopaedics requiring a closed reduction of a forearm fraction under either sedation or general anaesthetic.
- Patients who are able to return to follow up.
Exclusion Criteria:
- Any children with a history of gastrointestinal bleeding or ulceration, a bleeding disorder, a history of a low platelet count, a history of kidney disease, an uncontrolled chronic disease, or regular use of or allergy to acetaminophen, ibuprofen, or codeine.
- Children are also ineligible if they or their parents are unable to understand the consent process.
- Any child requiring anything other than a cast to supplement the stability of the fracture or an open reduction and internal fixation of the fracture.
Open fractures.
Contacts and Locations| Contact: Paul Jellicoe, MD | 204-787-8948 | |
| Contact: James R McCammon, MD | 204-779-8673 | j_mccammon@hotmail.com |
| Canada, Manitoba | |
| Health Sciences Center | Not yet recruiting |
| Winnipeg, Manitoba, Canada | |
| Contact: Paul Jellicoe, MD Ph: 204 787 8948 pjellicoe@exchange.hsc.mb.ca | |
| Contact: James R McCammon, MD 204-779-8673 j_mccammon@hotmail.com | |
| Principal Investigator: Paul Jellicoe, MD | |
| Sub-Investigator: James R McCammon, MD, BSC(med), BMR(PT) | |
More Information
Publications:
| Responsible Party: | University of Manitoba |
| ClinicalTrials.gov Identifier: | NCT01605240 History of Changes |
| Other Study ID Numbers: | H2012:092 |
| Study First Received: | May 22, 2012 |
| Last Updated: | May 23, 2012 |
| Health Authority: | Canada: Research Ethics Board |
Keywords provided by University of Manitoba:
|
Fracture pain Fracture reduction Analgesia Acetaminophen |
Ibuprofen Codeine Pediatric Fracture Pain Analgesia in Pediatric population |
Additional relevant MeSH terms:
|
Fractures, Bone Pain, Postoperative Wounds and Injuries Postoperative Complications Pathologic Processes Pain Signs and Symptoms Acetaminophen Ibuprofen Codeine Antipyretics Physiological Effects of Drugs Pharmacologic Actions Analgesics, Non-Narcotic Analgesics |
Sensory System Agents Peripheral Nervous System Agents Central Nervous System Agents Therapeutic Uses Analgesics, Opioid Central Nervous System Depressants Antitussive Agents Respiratory System Agents Narcotics Anti-Inflammatory Agents, Non-Steroidal Anti-Inflammatory Agents Antirheumatic Agents Cyclooxygenase Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action |
ClinicalTrials.gov processed this record on May 19, 2013