From the Guidelines
For a 9-year-old patient with a fractured arm in the ER, the most effective oral liquid opioid pain medication is not recommended as a first-line treatment, instead, acetaminophen (10-15 mg/kg every 4-6 hours, not exceeding 5 doses in 24 hours) and ibuprofen (10 mg/kg every 6-8 hours with food) should be used, and for moderate to severe pain, intranasal fentanyl (1-2 mcg/kg) or intravenous morphine (0.05-0.1 mg/kg) may be administered, as evidenced by the most recent study 1. When considering pain management for a child with a fractured arm, it's essential to prioritize a multimodal approach that includes both pharmacological and non-pharmacological interventions.
- The use of acetaminophen and ibuprofen as first-line medications is supported by their ability to target pain through different mechanisms, with acetaminophen working centrally to block pain signals and ibuprofen reducing inflammation at the injury site 1.
- For moderate to severe pain, the administration of intranasal fentanyl or intravenous morphine may be necessary, with careful consideration of the potential side effects associated with opioid use, such as respiratory depression, nausea, and vomiting 1.
- Non-pharmacological approaches, including proper immobilization of the fracture with a splint, application of ice packs, elevation of the injured arm, and age-appropriate distraction techniques, should complement medication to provide comprehensive pain management 1.
- Regular pain assessment using age-appropriate scales, such as the FACES Pain Scale or numerical rating scale, is crucial to ensure that the pain management plan is effective and adjusted as needed 1.
From the Research
Pain Management for a 9-year-old Patient with a Fractured Arm
The recommended pain management for a 9-year-old patient with a fractured arm in the Emergency Room (ER) is a crucial aspect of their treatment.
- The choice of oral liquid opioid pain medication depends on various factors, including the severity of the pain, the patient's medical history, and the potential side effects of the medication.
- According to the study 2, oxycodone and hydrocodone are both effective in treating acute pain associated with fractures, with no significant difference in pain relief between the two medications at 30 and 60 minutes.
- However, the study 2 also found that hydrocodone patients had a higher incidence of constipation compared to oxycodone patients.
- Another study 3 compared the efficacy and tolerability of oxycodone 5 mg/ibuprofen 400 mg with those of oxycodone 5 mg/acetaminophen 325 mg, hydrocodone 7.5 mg/acetaminophen 500 mg, and placebo in a dental pain model, and found that oxycodone 5 mg/ibuprofen 400 mg provided significantly better analgesia throughout the 6-hour study.
- A more recent study 4 found that treatment with strong opioid medication subacutely was not superior to treatment with milder medication for treatment of pain among patients with surgically managed orthopedic fractures.
Considerations for Pediatric Patients
- When it comes to pediatric patients, such as a 9-year-old with a fractured arm, it is essential to consider the potential risks and benefits of opioid medications.
- The study 5 used a digital pill system to track oxycodone ingestion patterns in patients with acute fracture pain and found substantial variability in ingestion patterns between individuals.
- The study 6 compared the efficacy and tolerability of combination hydrocodone and ibuprofen versus combination oxycodone and acetaminophen in the treatment of moderate or severe acute low back pain, and found that both combinations were similarly effective and tolerable.
Oral Liquid Opioid Options
- Based on the available evidence, oral liquid opioid options for a 9-year-old patient with a fractured arm in the ER may include:
- Oxycodone
- Hydrocodone
- However, it is crucial to consult with a healthcare professional to determine the best course of treatment for the individual patient, taking into account their specific needs and medical history.