Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department

Abstract

BackgroundDespite the fact that numerous medications have been introduced to treat renal colic, none has been proven to relieve the pain rapidly and thoroughly. In this study, we aimed at comparing the effects of intravenous lidocaine versus intravenous morphine in patients suffering from renal colic.MethodsIn a prospective randomized double-blind clinical trial performed in the emergency department of Imam Reza educational hospital of Tabriz, Iran, we studied 240 patients, 18–65 years old, who were referred due to renal colic. Patients were divided into two groups. In group I (120 people) single-dose intravenous lidocaine (1.5 mg/kg) was administered and in group II (120 people) single-dose intravenous morphine (0.1 mg/kg) was administered slowly. Visual Analogue Pain Scale (VAS) was recorded while admission, 5, 10, 15 and 30 minutes after injection. Statistical data and results were studied using descriptive statistics as percentage and Mean ± SD. To compare the response to treatment, Mann–Whitney U-test was used in two groups. Consequently, the data were analyzed using the SPSS16 software.ResultsPain score measured in two groups five minutes after the injection of lidocaine and morphine were 65 % and 53 % respectively (95% CI 0.60 - 0.69, CI 0.48 – 0.57, p = 0.0002).108 (90 %) patients (95 % CI 0.84 – 0.95) from group I and 84 (70%) patients (95 % CI 0.62 - 0.78) from group II responded appropriately at the end of the complete treatment. The difference was statistically significant (p = 0.0001).ConclusionsChanging the smooth muscle tone and reducing the transmission of afferent sensory pathways, lidocaine causes a significant reduction in pain.Trial registrationClinical Trials IRCT138901042496N3

Intravenous Lidocaine for Acute Pain: A Systematic Review

“…A prospective double‐blind trial randomized 240 patients who presented to the ED with renal colic to receive either lidocaine 1.5 mg/kg IV or morphine 0.1 mg/kg IV as a single dose for acute pain control . The VAS scores were reported at 0, 5, 10, 15, and 30 minutes after each intervention.…”

“…Although the quality of evidence was very low, lidocaine was efficacious as an analgesic for a variety of acute pain indications. When lidocaine was studied against an active comparator, it showed a greater reduction in VAS and higher response rate as compared with morphine for both critical limb ischemia and renal colic . In addition, lidocaine showed no difference in efficacy compared with ketorolac for the treatment of acute radicular low back pain, possibly a result of lidocaine's antiinflammatory properties .…”

“…Remarkably, the incidence of cardiovascular and hepatic adverse events was low, yet patients with cardiovascular disease and hepatic disease were included in most of the trials. Only one trial excluded patients with a history of renal disease, liver disease, and cardiac disease . In all studies, liver function tests were routinely monitored at least once/day.…”

“…Although the optimal dosing regimen for analgesia has yet to be determined, IV lidocaine administration was shown to be safe for up to 48 hours. Dosing ranges for IV lidocaine used for analgesia varied and included a 1-to 2-mg/kg bolus dose, 19,21,22,30 a fixed 50-to 100-mg bolus dose, 20,23,29,37 and a 1-mg/kg/hour continuous infusion. 24,31,33 Because lidocaine dosing is weight based for all indications approved by the U.S. Food and Drug Administration, a reasonable dose of lidocaine for acute pain is a bolus between 1 and 2 mg/kg.…”

“…A prospective double-blind trial randomized 240 patients who presented to the ED with renal colic to receive either lidocaine 1.5 mg/kg IV or morphine 0.1 mg/kg IV as a single dose for acute pain control. 19 The VAS scores were reported at 0, 5, 10, 15, and 30 minutes after each intervention. The mean reduction in VAS at 30 minutes was 8.5 (VAS reduced from a score of 9.6 to 1.1) in the lidocaine group compared with 7.5 (VAS reduced from a score of 9.7…”