Intravenous morphine plus ibuprofen or ketorolac versus intravenous morphine alone in reducing renal colic pain intensity in emergency department: A randomized, double-blind clinical trial

Arash Safaie; Maryam Tavoli; Sepideh Babaniamansour; Ehsan Aliniagerdroudbari; Amirabbas Mousavi; Mehran Sotoodehnia; Maryam Bahreini

doi:10.4103/2452-2473.336108

Intravenous morphine plus ibuprofen or ketorolac versus intravenous morphine alone in reducing renal colic pain intensity in emergency department: A randomized, double-blind clinical trial

Turk J Emerg Med. 2022 Jan 20;22(1):8-14. doi: 10.4103/2452-2473.336108. eCollection 2022 Jan-Mar.

Authors

Arash Safaie^{1

2}, Maryam Tavoli³, Sepideh Babaniamansour⁴, Ehsan Aliniagerdroudbari⁵, Amirabbas Mousavi⁶, Mehran Sotoodehnia^{2

7}, Maryam Bahreini^{2

7}

Affiliations

¹ Department of Emergency Medicine, Khoula Hospital, Ministry of Health, Muscat, Oman.
² Prehospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.
³ Department of Emergency Medicine, Khomein University of Medical Sciences, Khomein, Iran.
⁴ School of Medicine, Islamic Azad University of Medical Sciences, Tehran, Iran.
⁵ School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁶ Department of Clinical Sciences, Faculty of Specialized Veterinary Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran.
⁷ Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran.

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.

Keywords: Emergency service; hospital; ibuprofen; ketorolac; pain management; renal colic.