Journal of Emergency Practice and Trauma

Intravenous acetaminophen versus morphine sulfate in pain management of acute renal colic: a randomized clinical trial

Document Type : Original Article

Authors

Seyyed Hosein Montazer 1
Behzad Feizzadeh 2
Farzad Bozorgi 1
Seyed Mohammad Hosseininejad 1
Ayyoub Barzegarnezhad 2
Iraj Golikatir 1
Fatemeh Jahanian 1
Hasan Motamed 1
Hamed Aminiahidashti 1

1 Department of Emergency Medicine, Mazandaran University of Medical Science, Sari, Iran

2 Department of Urology, Mazandaran University of Medical Science, Sari, Iran

https://doi.org/10.15171/jept.2017.33
Abstract
Objective: The main purpose in the treatment of renal colic patients in emergency department is pain management. This study aimed to compare the analgesic effects of intravenous (IV) acetaminophen and morphine sulfate in this regard.
Methods: This double blind clinical trial was conducted on >18 years old renal colic patients in need of pain management in emergency department. Pain severity was recorded as 15, 30, and 60 minutes before injection, and 120 minutes after injection. In addition, side effects were compared between IV acetaminophen and morphine sulfate groups using SPSS version 16.
Results: A total of 355 patients were randomly allocated to one of the treatment groups. There were no significant differences between the two groups regarding baseline characteristic of participants. There was no significant difference in the pain intensity of the groups; 15 (P = 0.13) and 30 (P = 0.15) minutes after treatment. Although, the difference in pain severity was statistically significant between the two groups; 60 (P = 0.02) and 120 (P = 0.003) minutes after the infusion. This was not clinically important. The prevalence of side effects in morphine group was higher than the acetaminophen group (RR: 2.14, 95% CI: 1.53-2.98, P< 0.0001).
Conclusion: Based on the findings, IV morphine sulfate and acetaminophen had equal effectiveness regarding acute renal colic pain management, but considering the significantly higher frequency of side effects, IV acetaminophen seems to be a more reasonable choice in this regard.

Keywords

Renal colic
Morphine
Acetaminophen
Pain management
Emergency Service
Subjects
  1.  Gupta R, Gupta A, Singh G, Suri A, Mohan SK, Gupta CL. PCNL--A comparative study in nonoperated and in previously operated (open nephrolithotomy/ pyelolithotomy) patients--a single-surgeon experience. Int Braz J Urol 2011; 37(6): 739-44.
  2. Smith AD, Preminger G, Badlani G, Kavoussi LR. Smith’s Textbook of Endourology. 3rd ed. John Wiley & Sons; 2012.
  3. Dave C. Nephrolithiasis. Updated Dec 3, 2016. http:// www.emedicine.com/med/topic3437.htm.
  4. Rezakhaniha B, Safari Nezhad MR, Markazi Moghaddam N, Valimanesh HA, Abd Elahian M. The comparison of the efficay of commom pain management in acute renal colic. Annals of Military and Health Sciences Research 2004; 2(3): 381-5.
  5. Masarani M, Dinneen M. Ureteric colic: new trends in diagnosis and treatment. Postgrad Med J 2007; 83(981): 469-72. doi: 10.1136/pgmj.2006.055913.
  6. Kallidonis P, Liourdi D, Liatsikos E. Medical treatment for renal colic and stone expulsion. Eur Urol Suppl 2011; 10(5): 415-22. doi: 10.1016/j.eursup.2011.07.003.
  7. Safdar B, Degutis LC, Landry K, Vedere SR, Moscovitz HC, D’Onofrio G. Intravenous morphine plus ketorolac is superior to either drug alone for treatment of acute renal colic. Ann Emerg Med 2006; 48(2): 173-81.
  8. Bektas F, Eken C, Karadeniz O, Goksu E, Cubuk M, Cete Y. Intravenous paracetamol or morphine for the treatment of renal colic: a randomized, placebo-controlled trial. Ann Emerg Med 2009; 54(4): 568-74. doi: 10.1016/j.annemergmed.2009.06.501.
  9. Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol 2010; 12(2-3): e86-96.
  10. Cattabriga I, Pacini D, Lamazza G, Talarico F, Di Bartolomeo R, Grillone G, et al. Intravenous paracetamol as adjunctive treatment for postoperative pain after cardiac surgery: a double blind randomized controlled trial. Eur J Cardiothorac Surg 2007; 32(3): 527-31. doi: 10.1016/j.ejcts.2007.05.017.
  11. Remy C, Marret E, Bonnet F. State of the art of paracetamol in acute pain therapy. Curr Opin Anaesthesiol 2006; 19(5): 562-5. doi: 10.1097/01.aco.0000245285.30282.70.
  12. Kesimci E, Gumus T, Izdes S, Sen P, Kanbak O. Comparison of efficacy of dexketoprofen versus paracetamol on postoperative pain and morphine consumption in laminectomy patients. Agri 2011; 23(4): 153-9. doi: 10.5505/agri.2011.86548.
  13. Jahr JS, Lee VK. Intravenous acetaminophen. Anesthesiol Clin 2010; 28(4): 619-45. doi: 10.1016/j. anclin.2010.08.006.
  14. Goodman Gilman A, Rall TW, Nies AS, Taylor P. Opioid analgesics and antagonists. In: Goodman and Gilman’s: The Pharmacological Basis of Therapeutics. New York: McGraw-Hill; 1990. p. 485-521.
  15. Elvir-Lazo OL, White PF. The role of multimodal analgesia in pain management after ambulatory surgery. Curr Opin Anaesthesiol 2010; 23(6): 697-703. doi: 10.1097/ACO.0b013e32833fad0a.
  16. Juhl GI, Norholt SE, Tonnesen E, Hiesse-Provost O, Jensen TS. Analgesic efficacy and safety of intravenous paracetamol (acetaminophen) administered as a 2 g starting dose following third molar surgery. Eur J Pain 2006; 10(4): 371-7. doi: 10.1016/j.ejpain.2005.06.004.
  17. Morteza-Bagi HR, Amjadi M, Mirzaii-Sousefidi R. The comparison of apotel plus low dose of morphine and full dose of morphine in pain relief in patients with acute renal colic. Addict Health 2015; 7(1-2): 66-73.
  18. Masoumi K, Forouzan A, Asgari Darian A, Feli M, Barzegari H, Khavanin A. Comparison of clinical efficacy of intravenous acetaminophen with intravenous morphine in acute renal colic: a randomized, double-blind, controlled trial. Emerg Med Int 2014; 2014: 571326. doi: 10.1155/2014/571326.
  19. Grissa MH, Claessens YE, Bouida W, Boubaker H, Boudhib L, Kerkeni W, et al. Paracetamol vs piroxicam to relieve pain in renal colic. Results of a randomized controlled trial. Am J Emerg Med 2011; 29(2): 203-6. doi: 10.1016/j.ajem.2009.09.019.
  20. Hyllested M, Jones S, Pedersen JL, Kehlet H. Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: a qualitative review. Br J Anaesth 2002; 88(2): 199-214.
  21. Azizkhani R, Pourafzali SM, Baloochestani E, Masoumi B. Comparing the analgesic effect of intravenous acetaminophen and morphine on patients with renal colic pain referring to the emergency department: A randomized controlled trial. J Res Med Sci 2013; 18(9): 772-6.
  22. Serinken M, Eken C, Turkcuer I, Elicabuk H, Uyanik E, Schultz CH. Intravenous paracetamol versus morphine for renal colic in the emergency department: a randomised double-blind controlled trial. Emerg Med J 2012; 29(11): 902-5. doi: 10.1136/emermed-2011-200165.
Journal of Emergency Practice and Trauma
Volume 4, Issue 1
January 2018
Pages 39-43

  • Receive Date 16 August 2017
  • Revise Date 18 September 2017
  • Accept Date 18 September 2017

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