Page 109 WHO - Guidelines on the pharmacological treatment of persisting pain in children with medical illness

GRADE Table 1B

Author: Wiffen PJ
Date: 16-04-2009
Question: Should ibuprofen vs. codeine be used in children with musculoskeletal trauma (acute pain)?
Mean age: approximately 12 years.
Setting: Emergency department, Ottawa, ON, Canada.
Bibliography: Clark E et al. A randomised controlled trial of acetaminophen, ibuprofen and codeine
for acute pain relief in children with musculoskeletal trauma. Paediatrics, 2007, 119:460–467.

Summary of findings
Quality assessment No. of
patients Effect

No. of studies Design Limitations Inconsistency Indirectness Imprecision Other considerations Paracetamol Codeine Relative (95% CI) Absolute Quality

Pain relief measured as reduction in VAS at 60 minutes (follow-up: 120 minutes; measured with:
VAS pain; range of scores: 0–100; better indicated by lower values)
1 Rand- No No Serious a No None 112 112 – Paraceta- LOW
omized serious serious serious (ITT) (ITT) mol mean
trial limita- inconsist- impreci- 12 lower
tions ency sion (16 to 8
lower)
Codeine
11 mean
lower
(16 to 5
lower)
Minor adverse events (such as nausea, sleepiness, constipation)
1 Rand- No No Serious b No The vari- – – – 8/104 LOW
omized serious serious serious ability in Paraceta-
trial limita- inconsist- impreci- bio-trans- mol 8/104
tions ency sion formation Codeine
of codeine
not consid-
ered
CI, confidence interval; VAS, visual analogue scale; ITT, intention to treat.
a Study in acute pain setting. Doses: paracetamol 15 mg/kg (maximum 650 mg), codeine 1 mg/kg (maximum
60 mg). Data extracted as reported.
b Acute pain study. No significant difference between groups for adverse effects.

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