Quantifying the intensity of adverse events with ibuprofen and oxycodone: an observational cohort study

Objective 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. Design Observational cohort study. Setting Paediatric emergency department. Patients Patients (n=240) aged 4-16 years diagnosed with an acute fracture. Intervention Prescribed either ibuprofen (n=179) or oxycodone (n=61) for pain. Main outcome measures 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). Results On day 1, children using oxycodone were more likely to report any AE (chi(2)(1)=13.5, p<0.001), nausea (chi(2)(1)=17.0, p<0.001), vomiting (chi(2)(1)=11.2, p<0.001), drowsiness (chi(2)(1)=13.7,p<0.001), constipation (chi(2)(1)=8.9, p=0.003) and dizziness (chi(2)(1)=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-13(1)=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-33(1)=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. Conclusions 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.

Automated summary

The study aimed to compare the frequency and intensity of adverse events in children using ibuprofen versus oxycodone for pain management following acute fractures, with oxycodone associated with more frequent and intense AEs. Additionally, lower extremity fractures were found to result in more functional limitations. Clinicians should take these differences into consideration when providing fracture pain care for children.