Ibuprofen at Home After Orthopedic Surgery: A Better Option for Pain

Jessica Tomaszewski, MD
Primary Care Pediatrics, Nemours Children’s Health System, Wilmington, Delaware

Appropriate analgesia is an essential part of postoperative care, even in the setting of minor surgery, and inadequate pain control is the most common reason for associated unplanned hospital admissions. There is a growing need for standardization of care regarding outpatient analgesic choices, especially the use of opioids. With this in mind, Naveen Poonai, MD, and colleagues examined the efficacy of oral morphine vs ibuprofen at home after minor outpatient orthopedic surgery.

This study was a parallel-group, randomized, blinded superiority trial comparing oral morphine and ibuprofen in children aged 5 to 17 years who had undergone minor orthopedic surgical procedures. Participants took up to 8 doses of the intervention medication every 6 hours as needed for pain. The primary outcome was the presence of pain, determined by the Faces Pain Scale–Revised score, for the first dose. Secondary outcomes included medication adverse effects, additional pain medications required, unplanned health care visits, and subsequent pain score for doses 2 to 8.

In total, 154 participants were included, with 77 in each of the 2 arms of the study. The mean age of the participants was 12.4 years, and 46% were girls.

Both medications led to decreased pain scores with no difference in efficacy for the first dose or subsequent doses. There was also no significant difference in the number of participants who required acetaminophen for breakthrough pain.

Significantly more participants taking morphine reported adverse effects, most commonly drowsiness. Interestingly, 8 participants withdrew after initiation of the study, because they believed that ibuprofen would not adequately address the pain.

The authors noted that the study did have a few limitations. The participants had undergone a variety of surgical procedures, leading to baseline heterogeneity. There was concern that the fixed dosing interval in the study’s design would be a limitation, given the differing durations of action of morphine (2-4 h) and ibuprofen (4-8 h), but the authors’ analysis proved this concern to be unfounded.

This study’s results showed that ibuprofen was equally efficacious as an opioid analgesic such as oral morphine for at-home pain control after minor orthopedic surgical procedures, with fewer adverse effects, lower cost, no requirement for a prescription, fewer concerns for accidental ingestion, and fewer concerns for intentional abuse.

Reference:

Poonai N, Datoo N, Ali S, et al. Oral morphine versus ibuprofen administered at home for postoperative orthopedic pain in children: a randomized controlled trial. CMAJ. 2017;189(40): E1252-E1258. doi:10.1503/cmaj.170017.