Intravenous morphine plus ibuprofen or ketorolac versus intravenous morphine alone in reducing renal colic pain intensity in emergency department: A randomized, double-blind clinical trial
Arash Safaie1,2
, Maryam Tavoli3, Sepideh Babaniamansour4, Ehsan Aliniagerdroudbari5, Amirabbas Mousavi6, Mehran Sotoodehnia2,7, Maryam Bahreini2,7
1Department of Emergency Medicine, Khoula Hospital, Ministry of Health, Muscat, Oman
2Prehospital Emergency Research Center, Tehran University of Medical Sciences
3Department of Emergency Medicine, Khomein University of Medical Sciences, Khomein, Iran
4School of Medicine, Islamic Azad University of Medical Sciences
5School of Medicine, Shahid Beheshti University of Medical Sciences
6Department of Clinical Sciences, Faculty of Specialized Veterinary Sciences, Science and Research Branch, Islamic Azad University
7Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran
Keywords: Emergency service, hospital, ibuprofen, ketorolac, pain management, renal colic
Abstract
OBJECTIVES: This study aimed to compare the efficacy of intravenous (IV) morphine plus ibuprofen or ketorolac versus IV morphine alone in controlling renal colic pain in the emergency department.
METHODS: This double-blind, randomized clinical trial was conducted during November 2018 and March 2019 in Iran. Patients aged 18–65 years with acute renal colic and numerical rating scale (NRS) score of higher than 6 of 10 were enrolled to the study. They were randomly assigned to I, K, and control groups receiving 5 mg morphine with 800 mg ibuprofen (n = 65), 5 mg morphine with 30 mg ketorolac (n = 65), or only 5 mg morphine (n = 65) intravenously, respectively. NRS was evaluated 0, 15, 30, 60, and 120 min after injection.
RESULTS: A total of 195 participants took part in the study. The presence of stone in pelvis area was higher in I group (P = 0.027). The mean rescue analgesic dose was higher in the control group and lower in K group (P = 0.031). From the 15th min, the NRS reduction in I and K group was higher than the control group (P < 0.001), but the difference between I and K group was not statistically significant in total (P = 1.0) or in the all follow-up time intervals (15th P = 0.864, 30th P = 0.493, 60th P = 0.493, and 120th min P = 1.0). The largest difference in pain reduction was observed in 120th min and mean of NRS was 2.9 (95% confidence interval [CI]: 2.6–3.3), 2.9 (95% CI: 2.6–3.3) and 7.0 (95% CI: 6.7–7.4) in I, K and control group, respectively. The adverse effects showed in 18.5%, 20.0%, and 13.8% of I, K, and control group, respectively.
CONCLUSION: IV ibuprofen plus morphine and IV ketorolac plus morphine had similar effects in reducing renal colic pain but were more effective than IV morphine alone.
The implementation protocol was approved by the Ethics Committee of Tehran University of Medical Sciences (code: IR. TUMS. VCR. REC.1398.844) on 6 August 2017.
AS: conceptualization; data curation; formal analysis; methodology; project administration; resources; supervision; validation; writing – review & editing. MT: data curation; investigation; methodology; visualization; writing – original draft. SB: data curation; investigation; visualization; writing – original draft; writing – review & editing. EA: data curation; visualization; writing – original draft; writing – review & editing. AM: methodology; data curation; investigation; visualization; writing – original draft; writing – review & editing. MS: conceptualization; methodology; project administration; resources; supervision; validation. MB: project administration; resources; supervision; validation.
None Declared.
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