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Abstract
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OBJECTIVE: Pain in pediatric musculoskeletal injuries can lead to increased anxiety, fear, and avoidance of medical care, making analgesic management critical. Therefore, we evaluated analgesic efficacy and adverse effects to select the optimal analgesic agent in pediatric patients with musculoskeletal injuries.
METHODS: Four databases were searched from inception to March 2023 for peer-reviewed, open randomized controlled trials (RCTs). Inclusion criteria were: 1) trials with RCT design, 2) children aged 1 month-18 years with musculoskeletal injury, 3) outpatient setting, 4) interventions and control, 5) primary outcome: pain score at 60 and 120 min; secondary outcome: adverse effects, and 6) full-text and peer-reviewed articles. Two reviewers screened, extracted data, and assessed the risk of bias. A frequentist random effects network meta-analysis (NMA) was performed. (R package version 4.1.2). Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation working group approach.
RESULTS: We included eight trials comprising 1645 children. Ibuprofen was significantly associated with pain reduction at 120 min, compared with acetaminophen (SMD, 0.31 [95% CI 0.11-0.51]; moderate certainty) and opioids (SMD, 0.34 [95% CI 0.20-0.48]; moderate certainty). Compared with opioids alone, ibuprofen-opioid combination was significantly associated with pain reduction at 120 min (SMD, 0.19 [95% CI 0.03-0.35]). No significant differences were found in pain interventions at 60 min. Ibuprofen had statistically fewer adverse events than opioids (RR, 0.54 [95% CI 0.33-0.90] moderate certainty) and ibuprofen with opioids (RR, 0.47 [95% CI 0.25-0.89] moderate certainty). In terms of limitations, the eight RCTs included had relatively small sample sizes; only two were high-quality RCTs.
CONCLUSIONS: Our NMA found ibuprofen to be the most effective and least adverse analgesic in pediatric patients with musculoskeletal injuries.
Language: en |