Page 118 WHO - Guidelines on the pharmacological treatment of persisting pain in children with medical illness

GRADE Table 9 (table excluded during the evidence appraisal as not
addressing the clinical questions on comparison of strong opioids and
route of administration within the scope of these guidelines) A1

Author: Wiffen PJ
Date: 17-04-2009
Question: Should oxycodone vs. ibuprofen or oxycodone/ibuprofen combination be used for initial
management of orthopaedic injury related pain in children aged 6–18 years?
Setting: Paediatric emergency department, USA.
Bibliography: Koller D et al. Effectiveness of oxycodone, ibuprofen or the combination in the initial A2
management of orthopaedic injury related pain in children. Emergency Care, 2007, 23:627–633.

Summary of findings
Quality assessment No. of
patients Effect

No. of studies Design Limitations Inconsistency Indirectness Imprecision Other considerations Oxycodone Oxycodone- Relative (95% CI) Absolute Quality A3
Ibuprofen

ibuprofen
combination

Pain (follow-up: mean 120 minutes; Faces Pain Scale, VAS reported by parents and nurses) a
1 Rand- No No Serious No None 22 22 No sig- – LOW A4 A4
omized serious serious -2 b serious 22 nificant –
trial limita- inconsist- impreci- differ-
tions ency sion ence
between
the three
treatment
groups c
Adverse events (follow-up: mean 120 minutes) A5
1 Rand- No No Serious No None De- – – – LOW
omized serious serious -2 a serious scrip- – –
trial limita- inconsist- impreci- tive
tions ency sion data d
CI, confidence interval; VAS, visual analogue scale.
a Doses: oxycodone 0.1 mg/kg (maximum 10 mg), ibuprofen 10 mg/kg (maximum 800 mg), combination both at A6
trial doses.
b Acute pain – orthopaedic injuries.
c Good pain relief achieved in the three groups. Reduction in Faces Pain Scales from approximately 7 to
approximately 3 (Scale 0–10).
d Eleven participants reported 14 adverse events, 9 of these in the combination group. Drowsiness was the most
common but numbers were low: ibuprofen 3, combination 3, oxycodone 1.
A7

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