Efficacy of an ibuprofen/codeine combination for pain management in children presenting to the emergency department with a limb injury: a pilot study

J Emerg Med. 2013 Feb;44(2):536-42. doi: 10.1016/j.jemermed.2012.06.027. Epub 2012 Dec 8.


Background: Fractures and severe sprains generate moderate to severe pain (>3/10). Despite this fact, pain management in children presenting to the Emergency Department (ED) with a musculoskeletal trauma is still suboptimal. Few studies have focused on the efficacy of a combination of an opioid with an anti-inflammatory drug to relieve this type of pain.

Study objective: To compare the efficacy of a combination of codeine with ibuprofen to ibuprofen alone on the intensity of pain experienced by children presenting to the ED with a musculoskeletal trauma to a limb.

Methods: This randomized, double-blind, placebo-controlled trial included patients aged 6 to 18 years. After triage, subjects were randomized to either ibuprofen (10 mg/kg, max 600 mg) and codeine (1 mg/kg, max 60 mg) orally, or ibuprofen (10 mg/kg, max 600 mg) and a placebo orally. Pain was assessed with the visual analog scale (0 to 10) at triage, and at 60, 90, and 120 min after medication administration. Differences on mean pain scores were compared between groups over time.

Results: We recruited 81 patients, 40 in the experimental group and 41 in the control group. No significant differences were observed in mean pain scores between groups at any time point. Mean pain scores were moderate at 90 min in both experimental and control groups (4.0 ± 2.4 vs. 4.1 ± 2.0, respectively). Side effects were minimal.

Conclusion: The addition of codeine to ibuprofen did not significantly improve pain management in children with musculoskeletal trauma to a limb. Pain control provided by the medications remained suboptimal for most patients.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Analgesics, Opioid / therapeutic use*
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Child
  • Codeine / therapeutic use*
  • Contusions / complications
  • Double-Blind Method
  • Drug Therapy, Combination
  • Emergency Service, Hospital
  • Extremities / injuries
  • Female
  • Fractures, Bone / complications
  • Humans
  • Ibuprofen / therapeutic use*
  • Male
  • Pain / drug therapy*
  • Pain / etiology
  • Pain Measurement
  • Pilot Projects
  • Sprains and Strains / complications


  • Analgesics, Opioid
  • Anti-Inflammatory Agents, Non-Steroidal
  • Codeine
  • Ibuprofen