When your little kid has surgery, it’s natural to feel scared and anxious, and to want to comfort her any way you can. But when it comes to pain meds, it’s best to show some restraint. A new study has found that while morphine is commonly prescribed to kids after surgery, ibuprofen works just as well—and is much safer.
The study, which was conducted at the London Health Sciences Centre and published today in the Canadian Medical Association Journal (CMAJ), looked at orthopaedic outpatient surgeries (such as keyhole surgeries on joints and tendon repairs) performed on about 150 five- to 17-year-olds. Patients were randomly assigned to receive either oral morphine (at a dose of 0.5 milligrams per kilogram of body weight) or ibuprofen (at a dose of 10 milligrams per kilogram of body weight) every six hours for two days after they were discharged from the hospital.
The drugs had almost identical effects on pain reduction, but while 69 percent of kids who took morphine experienced adverse effects (like nausea and drowsiness), just 39 percent who took ibuprofen had side effects.
The risk of side effects isn’t the only reason to consider avoiding opioid medications like morphine. A report released by Pacira Pharmaceuticals last month called “The United States for Non-Dependence: An Analysis of the Impact of Opioid Overprescribing in America” revealed that, in 2016, there were enough opioid prescriptions written for 10- to 19-year-olds for every one in five children to have their own prescription.
Paul Sethi, a commentator on the report and an orthopaedic surgeon at Orthopaedic and Neurosurgery Specialists in Greenwich, Connecticut, says that opioids are often overprescribed because pain is so subjective and doctors don’t want to underprescribe or leave patients in a pinch when they run out of meds. Since parents are in charge of most post-operative care (the London study points out that 80 percent of all surgeries on kids are outpatient procedures), they run into similarly difficult decisions about how long to continue doling out meds once they bring the prescription home.
“It breaks your heart to watch your child suffer through anything,” says Sethi. “You want to do something for your child and maybe you don’t realize that just one pain pill or two pain pills a day for an extended period of time can be dangerous.”
In addition to the short-term effects of opioids, which include things like constipation and loss of balance, the long-term danger is dependence for the patient—or for others in the household who could get their hands on the pills when they are overprescribed. Fortunately, Sethi says there are good alternatives. “Just because acetaminophen and ibuprofen are over-the-counter, we incorrectly assume that they’re not as effective or not as strong,” he says. “And I don’t believe that’s the case.”
Sethi encourages parents to ask their kids’ doctors about those alternative strategies for pain management at their pre-op appointment. “In the same way that you’re going to ask your doctor about the risks and benefits of the surgery, ask your doctor about the non-opioid alternatives that may be used to shorten your child’s exposure to opioids.”