Kariman Hamid, Majidi Alireza, Taheri Sara, Shahrami Ali, Hatamabadi Hamid Reza
Department of Emergency Medicine, Imam Hossein Medical Center, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Emergency Medicine, Shohadaye Tajrish Medical Center, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Bull Emerg Trauma. 2015 Apr;3(2):46-52.
To compare the analgesiceffects of Nitrous oxide and morphine sulfate in patients with acute renal colic due to urolithiasis.
This was randomized clinical trial being performed in Imam Hossein hospital affiliated with Shahid Beheshti University of Medical Sciences during a 1-year period from May2013 to May2014. A total of number of 100 patients, with an age range of 20-50 years, who presented with renal colic secondary to urolithiasis confirmed by ultrasonography were randomly assigned to receive morphine sulfate injection (0.1 mg/kg) with 100 mg diclofenac suppository (n=50) or Entonox exhalation (50% nitric oxide and 50% oxygen) for 30-minutes with 100 mg diclofenac suppository (n=50). Quantitative measurement was of pain was performed according to a visual analogue scale (VAS), before, 3, 5, 10 and 30-minute after the intervention. The pain severity and side effects were measured between two study groups.
The baseline characteristics of the patients in two study groups were comparable. The frequencies of pain persistence (at least 50%) at 3-, 5-, 10- and 30-minute intervals in morphine sulfategroup were 96%, 80%, 50% and 8%, respectively; these frequencies in Entonex were 82%, 42%, 12% and 2%, respectively (p<0.001). Cox regression modeling showed that use of Entonox was the only effective agent in the success of treatment, compared to the use of morphine, i.e. use of Entonox increased the success of treatment up to 2.1 folds compared to the use of morphine (HR=2.1; 95% CI: 1.2-3.6; p=0.006).
The results of the present study demonstrate that inhalation of Entonox is an effective and safe analgesic regimen for acute renal colic. It acts more rapidly and is more potent in relieving renal colic when compared to morphine sulfate.Entonox can be regarded as an appropriate alternative to analgesics like opioids in this ground.
比较氧化亚氮和硫酸吗啡对尿路结石所致急性肾绞痛患者的镇痛效果。
这是一项随机临床试验，于2013年5月至2014年5月在沙希德·贝赫什提医科大学附属伊玛目侯赛因医院进行，为期1年。共有100例年龄在20至50岁之间、经超声检查确诊为尿路结石继发肾绞痛的患者，被随机分为两组，一组接受硫酸吗啡注射液（0.1mg/kg）加100mg双氯芬酸栓剂（n = 50），另一组接受恩托诺克斯气体（50%氧化亚氮和50%氧气）吸入30分钟加100mg双氯芬酸栓剂（n = 50）。在干预前、干预后3、5、10和30分钟，根据视觉模拟评分法（VAS）对疼痛进行定量测量。比较两个研究组的疼痛严重程度和副作用。
两个研究组患者的基线特征具有可比性。硫酸吗啡组在3、5、10和30分钟时疼痛持续（至少50%）的频率分别为96%、80%、50%和8%；恩托诺克斯组的这些频率分别为82%、42%、12%和2%（p<0.001）。Cox回归模型显示，与使用吗啡相比，使用恩托诺克斯是治疗成功的唯一有效药物，即与使用吗啡相比，使用恩托诺克斯使治疗成功率提高了2.1倍（HR = 2.1；95%CI：1.2 - 3.6；p = 0.006）。
本研究结果表明，吸入恩托诺克斯是治疗急性肾绞痛的一种有效且安全的镇痛方案。与硫酸吗啡相比，它起效更快，缓解肾绞痛的效果更强。在这方面，恩托诺克斯可被视为阿片类等镇痛药的合适替代品。
