Intravenous morphine plus ibuprofen or ketorolac versus intravenous morphine alone in reducing renal colic pain intensity in emergency department

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.

Prevention, diagnosis, and treatment of urolithiasis in geriatric patients - differences, similarities and caveats in comparison to the general population

“…either one alone [20]. If timely and substantial analgesia cannot be achieved, the suggested course of action is either active stone removal or acute urine drainage [11].…”

“…]. Due to its higher stone free rate (SFR) coupled with a lower likelihood of complications compared to PCNL, URS is now considered the first-line therapy, especially for elderly patients, even for stones exceeding 20 ] compared findings from six mostly retrospective studies that defined the elderly group differently (range: !60 to !85 years) [60][61][62][63][64][65]. Additionally, insights from a recent retrospective study by Eredics et al [66] comparing outcomes of the three commonly employed surgical approaches adds important context to the changing field of urolithiasis care.…”

“…Opioids are the fallback choice when NSAIDs are contraindicated. NSAIDs and opioids together, however, might provide more thorough relief than either one alone [20]. If timely and substantial analgesia cannot be achieved, the suggested course of action is either active stone removal or acute urine drainage [11].…”

Comparing the Efficacy of Intravenous Morphine versus Ibuprofen or its Compound in Patients with Closed Limb Fractures

“…The morphine group received 100 ml of normal saline for 15 min and 0.1 mg/kg of morphine sulfate, increasing volume to 5 ml with normal saline for 5 min, intravenously. Previous studies guided the selection of drug doses (3,11,15,18,19).…”

“…For instance, morphine administration not only leads to general side effects such as sedation and respiratory suppression, but it can also increase nonunion fractures and delay healing in bone fractures. As a result, analgesics from other types of drugs can be considered as substitute drugs (10,11).…”