Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.
BMJ Paediatr Open. 2022 May;6(1). doi: 10.1136/bmjpo-2022-001428. Epub 2022 May 24.
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.
Observational cohort study.
Paediatric emergency department.
Patients (n=240) aged 4-16 years diagnosed with an acute fracture.
Prescribed either ibuprofen (n=179) or oxycodone (n=61) for pain.
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).
On day 1, children using oxycodone were more likely to report any AE (χ =13.5, p<0.001), nausea (χ =17.0, p<0.001), vomiting (χ =11.2, p<0.001), drowsiness (χ =13.7,p<0.001), constipation (χ =8.9, p=0.003) and dizziness (χ =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, F =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, F =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.
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.
量化接受布洛芬或羟考酮治疗的儿童在急性骨折后出现的不良反应（AE）的频率和强度，通常称为副作用。次要目标是量化功能障碍，并描述与不良反应相关的人口统计学和临床特征。
观察性队列研究。
儿科急诊室。
4-16 岁被诊断为急性骨折的患者（n=240）。
开具布洛芬（n=179）或羟考酮（n=61）治疗疼痛。
出院后前 3 天打电话给家属报告不良反应的出现和强度及其孩子的功能结果（进食、睡眠、玩耍或上学的能力）。
在第 1 天，使用羟考酮的儿童更有可能报告任何不良反应（χ=13.5，p<0.001）、恶心（χ=17.0，p<0.001）、呕吐（χ=11.2，p<0.001）、嗜睡（χ=13.7，p<0.001）、便秘（χ=8.9，p=0.003）和头晕（χ=19.1，p<0.001），与使用布洛芬的儿童相比。接受羟考酮的儿童在第 1 天报告腹痛严重程度更高（羟考酮：平均 5.4±3.1；布洛芬平均 2.5±1.4，F=6.5，p=0.02），在所有 3 天内报告便秘强度更差（羟考酮：平均 4.9±2.1；布洛芬平均 3.2±2.2，F=4.5，p=0.04）。使用羟考酮与第 1 天出现不良反应的几率增加相关（OR=1.31（95%CI 1.13-1.52））。更高的疼痛评分（OR=1.50（95%CI 1.12-2.01））、下肢骨折（OR=1.25（95%CI 1.07-1.47））和接受 ED 镇静（OR=1.16（95%CI 1.01-1.34））与缺课有关。更高的疼痛评分（OR=1.50（95%CI 1.14-1.97））和下肢骨折（OR=1.23（95%CI 1.07-1.43））也与玩耍减少有关。
与布洛芬相比，羟考酮总体上与更频繁的不良反应、更高强度的胃肠道不良反应和更大的功能限制有关。下肢骨折比上肢骨折造成更多的功能限制。临床医生在为儿童提供骨折疼痛护理时应考虑这些差异。
