Oxycodone versus codeine for triage pain in children with suspected forearm fracture: a randomized controlled trial.
OBJECTIVE
To compare the efficacy of pain reduction of triage oxycodone (O) versus codeine (C) to children with suspected forearm fractures.


METHODS
Children, aged 4 to 17 years, were randomized to receive O (0.2 mg/kg; maximum, 15 mg) or C (2 mg/kg; maximum, 120 mg) if isolated forearm fracture was suspected by the emergency department (ED) triage nurse. All other ED staff were blinded to the assignment. The primary outcome measure was a 5-point facial scale (0 = no pain, 4 = severe) completed by subjects to assess pain at baseline then at 30-minute intervals until ED discharge or procedural sedation for fractures requiring reduction. Ten adverse effects were assessed at baseline and the succeeding intervals. Identification of the most painful part of the visit was assessed at discharge. Efficacy and adverse effects of O versus C were compared using generalized estimate equation modeling.


RESULTS
One hundred seven subjects (mean age, 10.4 years; African American, 55%; males, 56%) were randomized to O (n = 51) or C (n= 56). Subjects taking O reported a pain score significantly lower than subjects taking C (0.4 faces, P = 0.01). Minor adverse effects occurred in both groups, but itching occurred less in O subjects (odds ratio, 0.37; 95% confidence interval, 0.14-0.99). The most painful part of the visit was radiography (O = 41%, C = 38%) followed by extremity examination (O = 16%, C = 13%) then casting (O = 8%, C = 13%).


CONCLUSIONS
Triage-administered O tended toward greater pain reduction compared with C in children with suspected forearm fractures. Although minor adverse effects occurred in both groups, itching occurred more in C. Identification of radiography as the most painful part of fracture evaluation underscores the need for early triage administration of analgesia for suspected fractures.
Charney
Rachel L
RL
Division of Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA.
Yan
Yan
Y
Schootman
Mario
M
Kennedy
Robert M
RM
Luhmann
Janet D
JD
D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002648:Child; D003061:Codeine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D010098:Oxycodone / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D011885:Radius Fractures / Q000150:complications*; D014218:Triage; D014458:Ulna Fractures / Q000150:complications*
D000701:Analgesics, Opioid; D010098:Oxycodone; D003061:Codeine