Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct 29;50(1):223.
doi: 10.1186/s13052-024-01791-x.

Paracetamol and ibuprofen fixed-dose combination for the management of acute mild-to-moderate pain in children: strengthening and enhancing of result of Nominal Group Technique through Delphi consensus

Emanuele Castagno  1 , Niccolò Parri  2 , Antonio D'Avino  3 , Elena Ferrari  4 , Paola Giovanna Marchisio  5   6 , Virginia Messia  7 , Maurizio Taglialatela  8 , Annamaria Staiano  9   10
Affiliations

Paracetamol and ibuprofen fixed-dose combination for the management of acute mild-to-moderate pain in children: strengthening and enhancing of result of Nominal Group Technique through Delphi consensus

Emanuele Castagno et al. Ital J Pediatr. .

Abstract

Background: Paracetamol and ibuprofen are the most commonly used drugs for pain treatment in children and their combination has shown improved analgesic effect compared to treatment with either drug alone. Current literature lacks specific guidelines regarding the settings in which this combination should be adopted.

Methods: The survey, conducted with Delphi methodology, involved 75 hospital and outpatient pediatricians with clinical experience in the management of pain in children. Pediatricians involved were asked to validate or not the results of the previous NominalGroup Tecnique (NGT) consensus and thus specify the optimal clinical settings in which the paracetamol/ibuprofen fixed-dose combination could be adopted.

Results: The results confirm the importance of the fixed-dose paracetamol and ibuprofen combination for the control of mild-to-moderate acute pain in children. Particularly, this association seems to be appropriate in case of headache, earache, odontalgia and musculoskeletal pain, and in specific settings such as post-operative and post-procedural pain. The broadening of the panel brought to slight variations in clinical management practices between hospital and outpatient specialists. Nonetheless, overall consensus supports the notion that the fixed dose combination is more efficacious than monotherapies and it is well tolerated. Moreover, experts unanimously agree on the usefulness of the combination for caregivers, leading to improved adherence and effectiveness.

Conclusions: Both the NGT consensus and the broader Delphi consensus confirm the usefulness of the paracetamol-ibuprofen fixed-dose combination in pediatric pain. This is attributed to its superior effectiveness compared to monotherapies, a good tolerability profile, and improved compliance and ease of use. Some pain settings related to chronic, inflammatory and rheumatological pathologies remain to be investigated to evaluate the use of this combination.

Keywords: Delphi consensus; Pain management; Paracetamol/ibuprofen fixed-dose combination; Pediatrics.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. International Association for the Study of Pain (IASP). (2021) Pain in Children: Management. https://www.iasp-pain.org/resources/fact-sheets/pain-in-children-managem...
    1. Benini F, Corsini I, Castagno E, et al. Consensus on Pediatric Pain in the emergency room: the COPPER project, issued by 17 Italian scientific societies. Ital J Pediatr. 2020;46:101. 10.1186/s13052-020-00858-9. - PMC - PubMed
    1. Gazal G, Mackie IC. A comparison of Paracetamol, ibuprofen or their combination for pain relief following extractions in children under general anaesthesia: a randomized controlled trial. Int J Paediatr Dent. 2007;17:169–77. 10.1111/j.1365-263x.2006.00806.x. - PubMed
    1. Marseglia GL, Alessio M, Da Dalt L, Giuliano M, Ravelli A, Marchisio P. Acute pain management in children: a survey of Italian pediatricians. Ital J Pediatr. 2019;45:156. 10.1186/s13052-019-0754-3. - PMC - PubMed
    1. Motov S, Butt M, Masoudi A, Palacios W, Fassassi C, Drapkin J, Likourezos A, Hossain R, Brady J, Rothberger N, Flom P, Zerzan J, Marshall J. Comparison of oral Ibuprofen and Acetaminophen with either Analgesic Alone for Pediatric Emergency Department patients with Acute Pain. J Emerg Med. 2020;58:725–32. 10.1016/j.jemermed.2020.02.010. - PubMed

LinkOut - more resources