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Randomized, Controlled Trial of Acetaminophen, Ibuprofen, and Codeine for Acute Pain Relief in Children With Musculoskeletal Trauma.

Landmark Series
Clark E, Plint AC, Correll R, Gaboury I, Passi B. A 
Pediatrics. 20


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This high quality RCT by local investigators rigorously compared acetaminophen, ibuprofen and codeine analgesics among children in the ED with MSK trauma and found ibuprofen to be statistically and clinically significantly superior on a self-reported validated visual acuity pain scale. JC attendees felt this trial supports a change in current practice.

UPDATED Journal Club - March 2013
Methodology Score: 4.5/5              
Usefulness Score: 4.5/5

This three-armed RCT in pediatric patients presenting with MSK pain at the Children’s Hospital of Eastern Ontario found that ibuprofen provided superior analgesia (∆VAS -24mm and 52% of patients achieving adequate analgesia at 60 min) than acetaminophen (∆VAS –12mm, 36%) and codeine (∆VAS –11mm, 40%). The group agreed that this study employed a robust methodology and supported the routine use of NSAIDS in musculoskeletal pain over codeine or acetaminophen (NNT=6 vs acetaminophen), but that a multimodal approach to analgesia would provide additional benefit.
By: Dr. Andrew Willmore

Epi Lesson – Multiple Arm Clinical Trials

Multiple-arm randomized trials can be more complex in their design, data analysis, and result reporting than two-arm trials. In an RCT with three arms, there are seven theoretically possible comparisons so it is important that the investigators define a priori which comparisons are of primary interest and whether they will assess global differences between all arms and/or will assess pair-wise differences of 2 arms at a time. 
By: Ian Stiell


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