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Child Health: Morphine Is Not Superior To Ibuprofen For Managing Childrens Pain Following Minor Orthopedic Surgery
Date Posted: 20/Jun/2018
Oral morphine versus ibuprofen administered at home for postoperative orthopaedic pain in children: a randomised controlled trial. CMAJ 2017;189:E1252–8.
Implications for practice and research
Nurses should encourage parents to use ibuprofen along with paracetamol as the first-line treatment for their children’s postoperative pain at home. Future research is needed to determine the added benefit versus risk of using morphine alongside ibuprofen for postoperative pain control.
Morphine and other opioids such as oxycodone and hydrocodone increasingly serve as the cornerstone of children’s postoperative pain treatment. Yet, opioid use may result in a number of complications, including respiratory depression, nausea, constipation and an increased risk for opioid misuse later in life. Given the associated risks, it is important that evidence support the use of opioids over other reliable analgesics such as ibuprofen and paracetamol. However, such evidence is lacking in paediatric outpatient surgery. To fill this gap in knowledge, Poonai et al set out to determine whether oral morphine is more effective than ibuprofen in controlling children’s pain at home following surgery.1

The primary aim was to determine whether oral morphine was superior to oral ibuprofen for controlling children’s postoperative pain at home. Participants were 154 children 5–17 years of age (mean age=12.4 years) undergoing outpatient orthopaedic surgery. Researchers performed an intention to treat randomised controlled trial, which meant that every subject was analysed according to their randomised treatment assignment. Intention-to-treat analysis reduced bias introduced by participants dropping out of the study or being non-compliant with their treatment allocation (ie, took both ibuprofen and morphine). In total, 77 patients were randomised to each medication. Participants rated pain using the Faces Pain Scale-Revised. The six-item Faces Pain Scale-Revised is a validated measure of children’s postoperative pain and is scored from 0 (no pain) to 10 (maximum pain). The primary outcome was the decrease in self-reported pain score following the first at home dose of pain medication.
On average, both morphine and ibuprofen provided clinically meaningful reduction of pain scores by one point (from 3 to 2; p=0.2) on the Faces Pain Scale-Revised. Thus, researchers concluded that oral morphine was not superior to oral ibuprofen for controlling children’s postoperative pain at home. An important secondary finding was that morphine was associated with more side effects compared with ibuprofen.
By Cornelius Botha Groenewald

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