Cordell W H, Larson T A, Lingeman J E, Nelson D R, Woods J R, Burns L B, Klee L W
Emergency Medicine and Trauma Center Methodist Hospital of Indiana, Indianapolis 46202.
Ann Emerg Med. 1994 Feb;23(2):262-9. doi: 10.1016/s0196-0644(94)70038-9.
To develop a protocol for the blinded IV titration of morphine and to compare the analgesic efficacy and side effect profile of indomethacin suppositories versus IV morphine in the treatment of acute ureteral colic.
Randomized, double-blind, double-dummy, two-period crossover study.
Emergency department of a central-city, teaching hospital.
Patients 18 to 75 years of age with pain suggestive of ureteral colic. Exclusions included pregnancy, adverse reactions to the study drugs, chronic nonsteroidal anti-inflammatory drug (NSAID) therapy, or any pain medicine taken within four hours of ED admission.
Patients were randomized to one of two groups: indomethacin 100-mg rectal suppository or morphine by IV titration (5-mg loading dose and up to two additional 2.5-mg doses if needed). At the end of 30 minutes, if adequate pain relief had not been obtained, treatment was crossed over.
Verbal analog scale (initial pain) and visual analog pain relief scale.
Seventy-five patients were entered into the study. Only data from those patients with stone presence confirmed by IV pyelogram or stone passage were analyzed. Twenty-four could not be evaluated (23 who did not meet criteria for stone presence and one whose pain resolved spontaneously before study medications could be administered). Of the remaining 51 patients, 31 received indomethacin first and 20 received morphine first. Morphine recipients reported more pain relief at ten minutes (P = .02), but at 20 and 30 minutes, no significant difference (P = .17 and .74, respectively) existed between the two groups.
IV morphine produced more rapid analgesia than rectally administered indomethacin. There were no significant differences in vital sign changes or number of side effects between the two treatment groups. This study is the first to compare an NSAID with morphine administered by IV titration, considered by many to be the "gold standard" for relief of acute, severe pain. Future studies could evaluate the simultaneous administration of an opioid combined with an NSAID or compare an IV titrated opioid with an IV NSAID.
制定一项吗啡静脉滴定的盲法方案，并比较吲哚美辛栓剂与静脉注射吗啡在治疗急性输尿管绞痛中的镇痛效果和副作用情况。
随机、双盲、双模拟、两阶段交叉研究。
市中心一家教学医院的急诊科。
年龄在18至75岁之间，有提示输尿管绞痛疼痛症状的患者。排除标准包括妊娠、对研究药物的不良反应、慢性非甾体抗炎药（NSAID）治疗，或在急诊科入院前四小时内服用过任何止痛药物。
患者被随机分为两组之一：100毫克吲哚美辛直肠栓剂或静脉滴定吗啡（5毫克负荷剂量，必要时最多额外增加两剂2.5毫克剂量）。30分钟结束时，如果未获得充分的疼痛缓解，则进行治疗交叉。
语言模拟量表（初始疼痛）和视觉模拟疼痛缓解量表。
75名患者进入研究。仅分析那些经静脉肾盂造影证实有结石或结石已排出的患者的数据。24名患者无法评估（23名不符合结石存在标准，1名在给予研究药物之前疼痛自行缓解）。在其余51名患者中，31名先接受吲哚美辛治疗，20名先接受吗啡治疗。吗啡接受者在10分钟时报告疼痛缓解更明显（P = 0.02），但在20分钟和30分钟时，两组之间无显著差异（分别为P = 0.17和0.74）。
静脉注射吗啡比直肠给药的吲哚美辛产生更快的镇痛效果。两个治疗组在生命体征变化或副作用数量方面无显著差异。本研究首次将非甾体抗炎药与静脉滴定吗啡进行比较，许多人认为静脉滴定吗啡是缓解急性、重度疼痛的“金标准”。未来的研究可以评估阿片类药物与非甾体抗炎药联合给药，或比较静脉滴定阿片类药物与静脉注射非甾体抗炎药。
