children with a clinical fracture of an upper or lower limb in the ED Age: 3 to 16 years
Group 1: , IN diamorphine spray 0.1 mg/kg Group 2: , IM morphine 0.2 mg/kg
Pain score on WBS at 30 minutes after analgesic administration
(i) Both medications significantly reduced pain (ii) Onset of pain relief was faster in the IN spray group than IM (lower pain scores at 5, 10, and 20 minutes) (iii) No difference between groups at 30 minutes
children with suspected fracture or dislocation Age: 4 to 17 years
Group 1: , ketorolac (SL) 0.5 mg/kg Group 2: , tramadol (SL) 2 mg/kg
McGrath scale for children up to 6 years and VAS for those older than 6 years. Primary outcome was MPS < 5/10 on a 0–10 VAS at 120 minutes.
(i) Significant reduction in mean pain scores in both groups (ii) No significant differences in pain scores between groups at 120 minutes (iii) Rescue dose of paracetamol-codeine administered in 2/60 children in the ketorolac group versus 8/65 in the tramadol group (not significant)
Note: medications were given orally, except where otherwise indicated. CAS: Color Analog Scale; IM: intramuscular; IN: intranasal; IV: intravenous; MPS: Mean Pain Score; RCT: Randomized Controlled Trial; SL: sublingual; VAS: Visual Analog Scale; WBS: Wong-Baker faces pain scale.