Comparison of Acetaminophen With Codeine and Ibuprofen for Children With Injuries
Comparison of Acetaminophen With Codeine and Ibuprofen for Children With Injuries
We compared the pain relief of acetaminophen with codeine versus ibuprofen for children ages
 5-18 years who came to the Pediatric Emergency Department with injuries to their arms or
 legs.
We conducted a randomized, double-blinded equivalence trial. Pediatric Emergency Department
 patients 5-18 years of age with acute extremity pain received acetaminophen-codeine (1 mg/kg
 as codeine) or ibuprofen (10 mg/kg). They provided Color Analog Scale pain scores at baseline
 and at 20, 40, and 60 minutes after medication administration. The primary outcome measured
 was the difference in changes in pain score at 40 minutes, compared against a previously
 described minimal clinically significant change in pain score of 2 cm. Additional outcomes
 included need for rescue medication and adverse effects.
Inclusion Criteria:

 -  5 to 18 years of age

 -  Spoke English as a primary language

 -  Complained of an extremity injury with tenderness to palpation from the clavicle or
 femoral neck to the distal phalanges

 -  Scored 5 or greater on a 10-point ordinal or Varni-Ryan pain scale administered at
 triage

 Exclusion Criteria:

 -  Allergy or prior adverse reaction to acetaminophen, codeine or ibuprofen;

 -  Administration of any analgesic within 6 hours of presentation;

 -  Significant deformity or vascular insufficiency of the extremity requiring immediate
 treatment as determined by the treating physician;

 -  Inability to use the study pain instrument;

 -  Any laceration near the suspected injury;

 -  Chronic hepatic or renal disease;

 -  Pregnancy in the third trimester;

 -  Concurrent use of contraindicated medications such as monoamine oxidase inhibitors; or

 -  Use of central nervous system depressants such as ethanol, benzodiazepines,
 barbiturates, antidepressants, or recreational drugs