Olsen Jon C, McGrath Norine A, Schwarz Dana G, Cutcliffe Brian J, Stern Jessica L
Department of Emergency Medicine, Lutheran General Hospital, Park Ridge, IL, USA.
Acad Emerg Med. 2008 Aug;15(8):718-22. doi: 10.1111/j.1553-2712.2008.00178.x. Epub 2008 Jul 11.
Patients presenting to the emergency department (ED) with suspected biliary colic often require intravenous (IV) analgesia. The choice of IV analgesia typically includes opioids and ketorolac. Although ultrasound (US) is the initial diagnostic study in these patients, nondiagnostic scans and a high clinical suspicion may require the patient to undergo hepatobiliary scintigraphy (HIDA). Opioids such as morphine interfere with the HIDA scan and thus may limit its value as an analgesic in the ED for these patients. Analgesics that do not interfere with HIDA scanning include ketorolac and butorphanol, an opioid agonist-antagonist. This study evaluates the efficacy of IV ketorolac compared to butorphanol for the treatment of biliary colic pain in the ED.
Between June 2005 and February 2007, a convenience sample of patients presenting to the ED with abdominal pain suspected to be biliary colic were randomized to receive either 30 mg of IV ketorolac or 1 mg of IV butorphanol. Pain level was assessed using a 1 to 10 "faces" visual analog pain scale initially, as well as 15 and 30 minutes after medication infusion. Side effect profiles and the need for rescue analgesia were also assessed. Patients and clinicians were blinded to the study drug given.
Forty-six patients were enrolled in the study. Both groups had similar demographics and baseline pain scores. The mean (+/-standard deviation [SD]) pain score in the butorphanol group decreased from 7.1 (+/-1.7) to 2.1 (+/-2.2) after 30 minutes. The mean (+/-SD) pain score in the ketorolac group decreased from 7.4 (+/-2.0) to 3.1 (+/-3.3) after 30 minutes. Both groups had similar needs for rescue analgesia. Side effects included dizziness and sedation with butorphanol and nausea with ketorolac.
Although limited by small sample size and convenience sample, this study demonstrates that both ketorolac and butorphanol provide pain relief in biliary colic. Both agents should be considered reasonable options in the ED treatment of biliary colic, especially in patients that may undergo HIDA.
因疑似胆绞痛而前往急诊科就诊的患者通常需要静脉注射镇痛药物。静脉镇痛药物的选择通常包括阿片类药物和酮咯酸。虽然超声检查（US）是这些患者的初始诊断性检查，但非诊断性扫描以及高度的临床怀疑可能需要患者接受肝胆闪烁显像（HIDA）检查。吗啡等阿片类药物会干扰HIDA扫描，因此可能会限制其在急诊科作为这些患者镇痛药物的价值。不干扰HIDA扫描的镇痛药包括酮咯酸和布托啡诺（一种阿片类激动剂-拮抗剂）。本研究评估了静脉注射酮咯酸与布托啡诺相比在急诊科治疗胆绞痛疼痛方面的疗效。
在2005年6月至2007年2月期间，将因疑似胆绞痛而前往急诊科就诊的腹痛患者的便利样本随机分为两组，分别接受30mg静脉注射酮咯酸或1mg静脉注射布托啡诺。最初使用1至10的“面部”视觉模拟疼痛量表评估疼痛程度，在药物输注后15分钟和30分钟也进行评估。还评估了副作用情况以及使用补救镇痛药的必要性。患者和临床医生对所给予的研究药物不知情。
46名患者纳入本研究。两组患者的人口统计学特征和基线疼痛评分相似。布托啡诺组的平均（±标准差[SD]）疼痛评分在30分钟后从7.1（±1.7）降至2.1（±2.2）。酮咯酸组的平均（±SD）疼痛评分在30分钟后从7.4（±2.0）降至3.1（±3.3）。两组使用补救镇痛药的需求相似。副作用包括布托啡诺引起的头晕和镇静以及酮咯酸引起的恶心。
尽管本研究受样本量小和便利样本的限制，但表明酮咯酸和布托啡诺均可缓解胆绞痛。在急诊科治疗胆绞痛时，尤其是对于可能接受HIDA检查的患者，这两种药物都应被视为合理的选择。
