Abstract
Objectives
Renal colic (RC) is a common cause for emergency department visits. This study was
conducted to compare the analgesic efficacy of morphine plus ketamine (MK) versus
morphine plus placebo (MP) in patients with acute renal colic.
Method
Using a single center, double-blind, two-arm, parallel-group, randomized controlled
trial, 200 patients were equally and randomly divided to receive 0.1 mg/kg morphine
plus normal saline and 0.1 mg/kg morphine plus 0.2 mg/kg ketamine. The severity of
renal colic was assessed by VAS at baseline, 20 and 40 min after drug injection. The
number of adverse events also was recorded.
Results
Totally, 200 patients completed the study. Mean age of the patients was 35.60 ± 8.17 years.
The patients were mostly men (68.5%). The severity of pain between the groups was
not significantly different at baseline. Both groups showing a significant reduction
in VAS scores across the three time points. The main effect comparing the two types
of intervention was significant (F = 12.95, p = 0.000), suggesting a significant reduction in pain severity of patients in the
MK group. The number of patients who suffered from vomiting was significantly higher
in MP group than that of MK group (13 and 3, respectively (P = 0.009)). However, the risk of dizziness in the MK group was >2 times higher than
MP group (relative risk: 2.282, 95% CI: 1.030–5.003, P = 0.039). The number of patients who needed rescue analgesia was significantly lower
in the MK group (OR, 0.43 (0.22–0.83)).
Conclusion
Adding 0.2 mg/kg ketamine to 0.1 mg/kg morphine can reduce the renal colic pain, nausea
and vomiting more than morphine alone; however, it was associated with higher number
of patients with dizziness.
Keywords
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References
- Acute renal colic from ureteral calculus.N Engl J Med. 2004; 350: 684-693
- Delivering safe and effective analgesia for management of renal colic in the emergency department: a double-blind, multigroup, randomised controlled trial.Lancet. 2016; 387: 1999-2007
- Nonsteroidal anti-inflammatory drugs (NSAIDs) and non-opioids for acute renal colic.Cochrane Database Syst Rev. 2015; 6Cd006027
- Pharmacologic interventions to treat renal colic pain in acute stone episodes: systematic review and meta-analysis.Prog Urol. 2017; 27: 654-665
- Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic.BMJ. 2004; 328: 1401
- Can the addition of low dose lidocaine improve the effectiveness of narcotics in reducing renal colic pain?.Am J Emerg Med. 2018; 36: 721-722
- Efficacy and safety of combination therapy with ketorolac and morphine in patient with acute renal colic; a triple-blind randomized controlled clinical trial.Bull Emerg Trauma. 2017; 5: 165-170
- Does lidocaine as an adjuvant to morphine improve pain relief in patients presenting to the ED with acute renal colic? A double-blind, randomized controlled trial.Am J Emerg Med. 2016; 34: 443-448
- Can intracutaneous sterile water injection be used as a possible treatment for acute renal colic pain in the emergency department? A short literature review.Urol Ann. 2015; 7: 130-132
- What is the best analgesic option for patients presenting with renal colic to the emergency department? Protocol for a systematic review and meta-analysis.BMJ Open. 2017; 7
- A systematic review and meta-analysis of ketamine as an alternative to opioids for acute pain in the emergency department.Acad Emerg Med. 2018; 00: 1-11https://doi.org/10.1111/acem.13502
- Comparison of intranasal ketamine versus IV morphine in reducing pain in patients with renal colic.Am J Emerg Med. 2017; 35: 434-437
- Aromatherapy as a promising adjunctive treatment for acute renal colic pain: an issue that merits further research.. 2017; 45: 231-232
- Ketamine for chronic pain: risks and benefits.Br J Clin Pharmacol. 2014; 77: 357-367
- Can low-dose of ketamine reduce the need for morphine in renal colic? A double-blind randomized clinical trial.Am J Emerg Med. 2018; 36: 376-379
- Is there a role for intravenous subdissociative-dose ketamine administered as an adjunct to opioids or as a single agent for acute pain management in the emergency department?.J Emerg Med. 2016; 51: 752-757
- Low dose ketamine use in the emergency department, a new direction in pain management.Am J Emerg Med. 2017; 35: 918-921
- Low-dose ketamine vs morphine for acute pain in the ED: a randomized controlled trial.Am J Emerg Med. 2015; 33: 402-408
- Effective analgesia with low-dose ketamine and reduced dose hydromorphone in ED patients with severe pain.Am J Emerg Med. 2013; 31: 847-851
- The use of ketamine for acute treatment of pain: a randomized, double-blind, placebo-controlled trial.J Emerg Med. 2017; 52: 601-608
- Ketamine for pain management-side effects & potential adverse events.Pain Manag Nurs. 2017; 18: 372-377
- The use of subdissociative-dose ketamine for acute pain in the emergency department.. 2015; 22: 251-257
Article Info
Publication History
Published online: September 03, 2018
Accepted:
September 2,
2018
Received:
August 22,
2018
Footnotes
☆RCT registration number: The study was registered at the Iraninan registry of clinical trial with ID: IRCT2015080523517N1.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
