For at-home management of children's fracture pain, ibuprofen seems to be a safe first-line therapy  for acute fracture-related pain when compared to oxycodone, says a prospective observational cohort study published in PLOS One. Samina Ali et al. aimed to investigate the safety and effectiveness of prescribing oxycodone and ibuprofen to alleviate fracture pain.

The study recruited 329 children aged 4-16 years (68% male) with an isolated fracture discharged home with a recommendation to use either oxycodone (n=112) or ibuprofen (n = 217).  Pain score reduction as estimated by Faces Pain Score-Revised (FPS-R) score on Day 1 after discharge was the major endpoint.

The fracture distribution incorporated 80.5% (264/329) upper limb with 34.3% (113/329) needing fracture reduction. The mean decline in the FPS-R score (maximum pain-post-treatment pain) for Day 1,2 and 3 for the study groups are shown in Table 1. Compared to oxycodone-prescribed children, ibuprofen-prescribed children reported fewer adverse events and less impact on their function (sleep, play, eat, school) on Day 1 (Table 1).

For at-home fracture pain, both ibuprofen or oxycodone showed similar analgesic efficacy. However, oxycodone prescribing was related to higher adverse events and negatively influenced the functional outcomes. The use of oxycodone exhibit a negative adverse effect profile and does not seem to confer any advantage over ibuprofen for mitigation of fracture-related pain.