Ibuprofen is currently considered first-line management for acute paediatric musculoskeletal injuries, although numerous studies have established that pain management is still sub-optimal. Samina Ali and colleagues conducted two RCTs investigating addition of either paracetamol or an opioid (hydromorphone) to ibuprofen for pain relief following presentation for acute musculoskeletal injury (not requiring surgery). A total of 653 patients were included in the analyses. Pain scores 60 minutes after medication was administered did not improve with the addition of paracetamol or hydromorphone compared to those who received ibuprofen alone. Adverse events were more frequent in those who received the opioid.

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