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Home/Large Joints and Extremities/Kids Should Not Get Morphine?
Large Joints and Extremities

Kids Should Not Get Morphine?

October 28, 2014 1 min read Premium comments

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Kids Should Not Get Morphine?
Source: Morguefile and Mary R. Vogt
Secondary

You don’t often hear “morphine” and “children” in the same phrase. But, says a new study from Canada, giving morphine to children is getting more common. The study involving 134 children, the authors found that for cases of broken limbs, ibuprofen should be given to kids instead of morphine due to adverse events associated with the latter drug.

“Evidence suggests that orally administered morphine and other opioids are increasingly being prescribed, ” writes Dr. Naveen Poonai, London Health Sciences Centre and Western University, London, Ontario, with co-authors, in the October 27, 2014 news release. “However, evidence for the oral administration of morphine in acute pain management is limited. Thus, additional studies are needed to address this gap in knowledge and provide a scientific basis for outpatient analgesic choices in children.”

In this randomized trial published in CMAJ (Canadian Medical Association Journal), “researchers compared oral morphine (66 participants) with ibuprofen (68 participants) to determine if oral morphine was better at relieving pain in children with fractures that did not need surgery. Although both analgesics were effective at reducing pain, oral morphine was associated with more adverse events, such as drowsiness, nausea, vomiting.”

The authors indicate that the study is in line with findings from other studies indicating that ibuprofen is an effective pain reliever.

“Given that morphine was associated with significantly more adverse effects, we conclude that ibuprofen remains a safe and effective therapy for outpatient management of children’s fracture pain, ” write the authors. “We hope that our results will provide clinicians with a foundation for rational analgesic choices for children with fractures who are discharged from the emergency department.”

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Discussion

14
DS
Dr. Sarah MitchellOrthopedic Surgeon · Mayo Clinic

This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?

8
JT
James Thornton, MDSpine Fellow · HSS

Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.

5
RP
R. PatelSports Medicine · Stanford

We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.

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