JAMA Pediatr

Pediatric analgesics compared: Which drug class came out on top?

February 5, 2025

Compared with placebo, NSAIDs, ketamine, and mid- to high-potency opioids effectively reduce acute pediatric pain. NSAIDs offer the most benefit with the least risk, making them the preferred first-line treatment for acute pain in children.

Study details: This systematic review and network meta-analysis evaluated various pharmacologic treatments for managing acute pain in children. The study synthesized data from multiple randomized trials to compare the efficacy and safety of different medications.

Results: A total of 41 trials with 4,935 children were analyzed. High- to moderate-certainty evidence showed that NSAIDs (weighted mean difference [WMD], -1.29; modeled risk difference [RD], 16%), ketamine (WMD, -1.12; RD, 14%), and mid- to high-potency opioids (WMD, -1.19; RD, 15%) effectively reduced pain compared with placebo. Only NSAIDs significantly decreased the need for rescue medication (relative risk [RR], 0.31; RD, 16%). Neither NSAIDs (RR, 0.69) nor acetaminophen (RR, 0.63) increased short-term GI adverse events. Other comparisons showed little to no difference from placebo or were based on low/very low-certainty evidence.

Source:

Olejnik L, et al. (2025, February 3). JAMA Pediatr. Pharmacologic Management of Acute Pain in Children: A Systematic Review and Network Meta-Analysis. https://pubmed.ncbi.nlm.nih.gov/39899301/