Safaie Arash, Tavoli Maryam, Babaniamansour Sepideh, Aliniagerdroudbari Ehsan, Mousavi Amirabbas, Sotoodehnia Mehran, Bahreini Maryam
Department of Emergency Medicine, Khoula Hospital, Ministry of Health, Muscat, Oman.
Prehospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Turk J Emerg Med. 2022 Jan 20;22(1):8-14. doi: 10.4103/2452-2473.336108. eCollection 2022 Jan-Mar.
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.
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 ( = 65), 5 mg morphine with 30 mg ketorolac ( = 65), or only 5 mg morphine ( = 65) intravenously, respectively. NRS was evaluated 0, 15, 30, 60, and 120 min after injection.
A total of 195 participants took part in the study. The presence of stone in pelvis area was higher in I group ( = 0.027). The mean rescue analgesic dose was higher in the control group and lower in K group ( = 0.031). From the 15 min, the NRS reduction in I and K group was higher than the control group ( < 0.001), but the difference between I and K group was not statistically significant in total ( = 1.0) or in the all follow-up time intervals (15 = 0.864, 30 = 0.493, 60 = 0.493, and 120 min = 1.0). The largest difference in pain reduction was observed in 120 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.
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.
本研究旨在比较静脉注射吗啡联合布洛芬或酮咯酸与单纯静脉注射吗啡在急诊科控制肾绞痛疼痛方面的疗效。
这项双盲、随机临床试验于2018年11月至2019年3月在伊朗进行。纳入年龄在18 - 65岁、急性肾绞痛且数字评分量表（NRS）评分高于6分（满分10分）的患者。他们被随机分为I组、K组和对照组，分别静脉接受5毫克吗啡加800毫克布洛芬（n = 65）、5毫克吗啡加30毫克酮咯酸（n = 65）或仅5毫克吗啡（n = 65）。注射后0、15、30、60和120分钟评估NRS。
共有195名参与者参加了该研究。I组盆腔区域结石的存在率更高（P = 0.027）。对照组的平均补救镇痛剂量更高，K组更低（P = 0.031）。从15分钟起，I组和K组的NRS降低幅度高于对照组（P < 0.001），但I组和K组之间的差异在总体上（P = 1.0）或所有随访时间间隔内（15分钟P = 0.864，30分钟P = 0.493，60分钟P = 0.493，120分钟P = 1.0）均无统计学意义。在120分钟时观察到最大的疼痛减轻差异，I组、K组和对照组的NRS平均值分别为2.9（95%置信区间[CI]：2.6 - 3.3）、2.9（95%CI：2.6 - 3.3）和7.0（95%CI：6.7 - 7.4）。I组、K组和对照组的不良反应发生率分别为18.5%、20.0%和13.8%。
静脉注射布洛芬加吗啡和静脉注射酮咯酸加吗啡在减轻肾绞痛疼痛方面效果相似，但比单纯静脉注射吗啡更有效。
