P MSK INJURY X IBUPROFEN

 A

BGT – Acetaminophen or Opioid Added to Ibuprofen for Children’s MSK Injury

JAMA 2025 | Ali et al. | KidsCAN PERC NO OUCH Trials

• Population: Children 6–17 yrs with acute (<24h) non-operative limb injury, pain ≥5/10

• Intervention:

  • Ibuprofen (10 mg/kg) + hydromorphone (0.05 mg/kg)

  • Ibuprofen + acetaminophen (15 mg/kg)

• Comparator: Ibuprofen alone

• Primary outcome: Pain score at 60 min (MCID 1.5)

Key Findings

• No clinically meaningful reduction in pain at 60 min with:

  • Ibuprofen + hydromorphone

  • Ibuprofen + acetaminophen

• Mean pain scores were nearly identical across groups

• Hydromorphone caused ~4× more adverse events

• No serious adverse events reported

Clinical Takeaway

• Ibuprofen alone is sufficient first-line therapy for most acute pediatric MSK injuries

• Adding acetaminophen provides no additional benefit at 60 min

• Adding opioid provides no benefit + increased harm

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One-Line Tagline

“For pediatric limb injuries: Ibuprofen works — adding paracetamol or opioids doesn’t, and opioids add harm.”