Pain Medication for a 16-Year-Old Male with Dislocated Elbow
For a 16-year-old male with a dislocated elbow, acetaminophen (paracetamol) is the most appropriate pain medication to prescribe on discharge, with ibuprofen as an alternative if there are no contraindications. 1, 2
First-Line Pain Management
Acetaminophen (Paracetamol)
- Dosing: 1000 mg every 8 hours (2 caplets of 500 mg)
- Maximum daily dose: 4000-6000 mg (not exceeding 6 caplets in 24 hours) 2
- Administration: Take with water, swallow whole
- Duration: Not to exceed 10 days unless directed by a doctor
Alternative: Ibuprofen
- Dosing: 400 mg every 4-6 hours as needed for pain relief 3
- Maximum daily dose: 3200 mg
- Administration: Take with meals or milk if gastrointestinal complaints occur
- Duration: Short-term use (5-7 days)
Rationale for Medication Selection
The European Society for Paediatric Anaesthesiology (ESPA) recommends oral NSAIDs and/or paracetamol as first-line treatment for post-traumatic pain management in adolescents 1. For this 16-year-old patient:
Acetaminophen is preferred because:
- No risk of bleeding complications
- No interference with bone healing
- Lower risk of gastrointestinal side effects
- Safe and effective for moderate pain in adolescents
Ibuprofen is an acceptable alternative when:
- Additional anti-inflammatory effect is desired
- Patient has previously tolerated it well
- No contraindications exist (bleeding disorders, renal issues)
Important Considerations
Avoid in This Patient
- Tramadol and other opioids should be avoided as first-line treatment for a simple dislocated elbow in an adolescent 1
- Long-term NSAID use due to potential renal, GI, and cardiac toxicities 1
Monitoring and Follow-up
- Instruct patient to contact healthcare provider if:
- Pain is not adequately controlled with prescribed medication
- Any adverse effects occur (nausea, vomiting, abdominal pain)
- Increased swelling, redness, or new symptoms develop at injury site
Patient Education
- Provide clear written instructions on medication dosing and timing
- Emphasize importance of not exceeding maximum daily dose
- Advise on proper elbow care (elevation, ice application for first 24-48 hours)
- Explain expected recovery timeline and when to begin gentle range of motion exercises
Special Considerations for Adolescents
- Adolescents metabolize medications differently than adults but similarly to adult patterns
- Acetaminophen is particularly safe in this age group when used as directed
- Ensure patient and parents understand the importance of following dosing instructions precisely
- Discourage self-adjustment of medication dosages
By following this approach, pain can be effectively managed while minimizing risks and promoting optimal recovery from the elbow dislocation.