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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 Publisher



Safaie A1, 2 ; Tavoli M3 ; Babaniamansour S4 ; Aliniagerdroudbari E5 ; Mousavi A6 ; Sotoodehnia M2, 7 ; Bahreini M2, 7
Authors
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Authors Affiliations
  1. 1. Department of Emergency Medicine, Khoula Hospital, Ministry of Health, Muscat, Oman
  2. 2. Prehospital Emergency Research Center, Tehran University of Medical Sciences, Iran
  3. 3. Department of Emergency Medicine, Khomein University of Medical Sciences, Khomein, Iran
  4. 4. School of Medicine, Islamic Azad University of Medical Sciences, Iran
  5. 5. School of Medicine, Shahid Beheshti University of Medical Sciences, Iran
  6. 6. Department of Clinical Sciences, Faculty of Specialized Veterinary Sciences, Science and Research Branch, Islamic Azad University, Iran
  7. 7. Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran

Source: Turkish Journal of Emergency Medicine Published:2022


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 15 th 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 (15 th P = 0.864, 30 th P = 0.493, 60 th P = 0.493, and 120 th min P = 1.0). The largest difference in pain reduction was observed in 120 th 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. © 2022 Turkish Journal of Emergency Medicine.
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1. Morphine Suppository Versus Indomethacin Suppository in the Management of Renal Colic: Randomized Clinical Trial, Pain Research and Treatment (2016)
2. Comparison of Intravenous Ketorolac at Three Doses for Treating Renal Colic in the Emergency Department: A Noninferiority Randomized Controlled Trial, Academic Emergency Medicine (2021)
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