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

Firouzian, Abolfazl; Alipour, Abbas; Dezfouli, Hale Rashidian; Kiasari, Alieh Zamani; Baradari, Afshin Gholipour; Zeydi, Amir Emami; Ahidashti, Hamed Amini; Montazami, Maryam; Hosseininejad, Seyed Mohammad; Kochuei, Farideh Yazdani

doi:10.1016/j.ajem.2015.11.062

Cited by 35 publications

(9 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…lidocaine can reduce visceral pain in experimental animal models 14e16 and alleviate abdominal pain in patients. 17,18 Colonic distension and traction during colonoscopy result in abdominal discomfort and visceral pain potentially amenable to i.v. lidocaine.…”

mentioning

confidence: 99%

Intravenous infusion of lidocaine significantly reduces propofol dose for colonoscopy: a randomised placebo-controlled study

Forster

Vanhaudenhuyse

Gast

et al. 2018

British Journal of Anaesthesia

View full text Add to dashboard Cite

Background: Propofol use during sedation for colonoscopy can result in cardiopulmonary complications. Intravenous lidocaine can alleviate visceral pain and decrease propofol requirements during surgery. We tested the hypothesis that i.v. lidocaine reduces propofol requirements during colonoscopy and improves post-colonoscopy recovery. Methods: Forty patients undergoing colonoscopy were included in this randomised placebo-controlled study. After titration of propofol to produce unconsciousness, patients were given i.v. lidocaine (1.5 mg kg À1 then 4 mg kg À1 h À1) or the same volume of saline. Sedation was standardised and combined propofol and ketamine. The primary endpoint was propofol requirements. Secondary endpoints were: number of oxygen desaturation episodes, endoscopists' working conditions, discharge time to the recovery room, post-colonoscopy pain, fatigue. Results: Lidocaine infusion resulted in a significant reduction in propofol requirements: 58 (47) vs 121 (109) mg (P¼0.02). Doses of ketamine were similar in the two groups: 19 (2) vs 20 (3) mg in the lidocaine and saline groups, respectively. Number of episodes of oxygen desaturation, endoscopists' comfort, and times for discharge to the recovery room were similar in both groups. Post-colonoscopy pain (P<0.01) and fatigue (P¼0.03) were significantly lower in the lidocaine group. Conclusions: Intravenous infusion of lidocaine resulted in a 50% reduction in propofol dose requirements during colonoscopy. Immediate post-colonoscopy pain and fatigue were also improved by lidocaine. Clinical trial registration: NCT 02784860.

show abstract

mentioning

confidence: 99%

Intravenous infusion of lidocaine significantly reduces propofol dose for colonoscopy: a randomised placebo-controlled study

Forster

Vanhaudenhuyse

Gast

et al. 2018

British Journal of Anaesthesia

View full text Add to dashboard Cite

show abstract

“…We attribute this increase to the departmental implementation of CERTA concept with specific emphasis on intravenous (IV) lidocaine as a viable alternative to opioids in patients with renal colic. 28 , 29 Additionally, we saw an increase by 384% of oral acetaminophen administration in the ED and by 321% at discharge, as well as 110% increase in naproxen administration at discharge. It is important to emphasize that the results of our study with overall decrease in ED opioid prescribing were not related to opioid shortages during the study periods.…”

Section: Discussionmentioning

confidence: 90%

Analgesic Administration for Patients with Renal Colic in the Emergency Department Before and After Implementation of an Opioid Reduction Initiative

Motov

Drapkin

Butt

et al. 2018

WestJEM

View full text Add to dashboard Cite

IntroductionWe aimed to evaluate the patterns of analgesic prescribing for emergency department (ED) patients suffering from pain of renal colic before, during, and after implementation of an opioid reduction initiative. We hypothesized that this initiative based on the concept of channels/enzymes/receptors-targeted analgesia would result in overall decrease in opioid utilization in the ED and at discharge.MethodsWe performed a retrospective analysis of ED electronic medical record of patients presenting with renal colic who received analgesics in the ED and at discharge over a five-year period. Patients were divided into three groups based on the following periods: 2012–2014 (pre-implementation phase); 2014–2015 (implementation phase); and 2015–2017 (post-implementation).ResultsA total of 4,490 patients presented to the ED with renal colic over a five-year study period. Analgesics were administered to 3,793 ED patients of whom 1,704 received opioids and 2,675 received non-opioid analgesics. A total of 3,533 ED patients received a prescription for analgesic(s) upon discharge from the ED: 2,692 patients received opioids, and 2,228 received non-opioids. We observed a 12.7% overall decrease from the pre-implementation to post-implementation time period in opioid prescribing in the ED and a 25.5% decrease in opioid prescribing at discharge, which translated into 432 and 768 fewer patients receiving opioids, respectively.ConclusionImplementation of an opioid-reduction initiative based on patient-specific, pain syndrome-targeted opioid alternative protocols resulted in a reduction in opioid administration in the ED by 12.7% and at prescriptions at discharge by 25.5%. Adoption of similar ED initiatives nationwide has the potential to foster effective non-opioid analgesic practices for ED patients presenting with renal colic and to reduce physicians’ reliance on administering and prescribing opioids.

show abstract

“…With reducing the speed of injection, we can provide enough time to compensate hypercarbia, by increasing the time for reaching opioids to the effect site ( 14 ). Another side effect of opioids is nausea and vomiting ( 18 ). In the present study there are no differences in the incidence of postoperative nausea and vomiting in all groups.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Different Analgesic Techniques for Pain Relief During Extracorporeal Shock Wave Lithotripsy: a Double-blind, Randomized Clinical Trial

Fouladi

Soleimani

2017

Acta Inform Med

View full text Add to dashboard Cite

Background:Most patients experience some degree of pain during extracorporeal shock waves lithotripsy (ESWL).Aim:The aim of this study was to evaluate the effect of target-controlled infusion (TCI) of remifentanil or sufentanil and patient-controlled analgesia (PCA) with sufentanil or morphine for pain relief during ESWL.Materials and Methods:In a double blind, randomized clinical trial, a total of 60 patients who were scheduled for elective ESWL, randomly assigned into four groups (A, B, C and D). Patients in group A and B received remifentanil and sufentanil with TCI, respectively. Also, patients in group C and D received sufentanil and morphine with PCA, respectively. All patients in four groups were assessed about the intensity of their pain with Visual Analogue Scale (VAS) in three phases; the discharge of the waves (phase A), during breaking the stones (phase B) and the end of the procedure (phase C).Results:Patients in morphine PCA group experienced highest pain intensity in all stages, but patients in remifentanil TCI group experienced lowest pain intensity during lithotripsy. Remifentanil/TCI group experienced the lowest pain in B and C phases and the sufentanil/TCI group had the lowest pain only in the phase A. There was no significant difference in the occurrence of complications in all four groups.Conclusion:The current study demonstrates that efficacy of TCI pump in the reduction of pain during ESWL is superior to the PCA pump. Among the drugs that used in this study, remifentanil has more effective in pain management in the all phases during ESWL. We believe that using remifentanil/TCI should strongly be considered to clinicians in ESWL units.

show abstract

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

Cited by 35 publications

References 41 publications

Intravenous infusion of lidocaine significantly reduces propofol dose for colonoscopy: a randomised placebo-controlled study

Intravenous infusion of lidocaine significantly reduces propofol dose for colonoscopy: a randomised placebo-controlled study

Analgesic Administration for Patients with Renal Colic in the Emergency Department Before and After Implementation of an Opioid Reduction Initiative

Comparison of Different Analgesic Techniques for Pain Relief During Extracorporeal Shock Wave Lithotripsy: a Double-blind, Randomized Clinical Trial

Contact Info

Product

Resources

About