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Qureshi I, Abdulrashid K, Thomas SH, Abdel-Rahman ME, Pathan SA, Harris T. Comparison of intravenous paracetamol (acetaminophen) to intravenously or intramuscularly administered non-steroidal anti-inflammatory drugs (NSAIDs) or opioids for patients presenting with moderate to severe acute pain conditions to the ED: systematic review and meta-analysis. Emerg Med J 2023; 40:499-508. [PMID: 37173122 DOI: 10.1136/emermed-2022-212869] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) and opiates/opioids, administered parenterally via intravenous or intramuscular route, are widely used to provide analgesia for patients with moderate to severe pain. This systematic review and meta-analysis evaluated the level of analgesia provided by intravenous paracetamol (IVP) alone compared with NSAIDs (intravenous or intramuscular), or opioids (intravenous) alone in adults attending the ED with acute pain. METHODS Two authors independently searched PubMed (MEDLINE), Web of Science, Embase (OVID), Cochrane Library, SCOPUS and Google Scholar (3 March 2021-20 May 2022) for randomised trials without any language or date restriction. Clinical trials were evaluated using the Risk of Bias V.2 tool. The primary outcome was mean difference (MD) for pain reduction at 30 min (T30) post analgesia delivery. The secondary outcomes were MD in pain reduction at 60, 90 and 120 min; the need for rescue analgesia; and the occurrence of adverse events (AEs). RESULTS Twenty-seven trials (5427 patients) were included in the systematic review and 25 trials (5006 patients) in the meta-analysis. There was no significant difference in pain reduction at T30 between the IVP group and opioids (MD -0.13, 95% CI -1.49 to 1.22) or IVP and NSAIDs (MD -0.27, 95% CI -1.0 to 1.54. There was also no difference at 60 min, IVP group versus opioid group (MD -0.09, 95% CI -2.69 to 2.52) or IVP versus NSAIDs (MD 0.51, 95% CI 0.11 to 0.91). The quality of the evidence using Grading of Recommendations, Assessments, Development and Evaluations methodology was low for MD in pain scores.The need for rescue analgesia at T30 was significantly higher in the IVP group compared with the NSAID group (risk ratio (RR): 1.50, 95% CI 1.23 to 1.83), with no difference found between the IVP group and the opioid group (RR: 1.07, 95% CI 0.67 to 1.70). AEs were 50% lower in the IVP group compared with the opioid group (RR: 0.50, 95% CI 0.40 to 0.62), whereas no difference was observed in the IVP group compared with the NSAID group (RR: 1.30, 95% CI 0.78 to 2.15). CONCLUSION In patients presenting to the ED with a diverse range of pain conditions, IVP provides similar levels of pain relief compared with opiates/opioids or NSAIDs at T30 post administration. Patients treated with NSAIDs had lower risk of rescue analgesia, and opioids cause more AEs, suggesting NSAIDs as the first-choice analgesia and IVP as a suitable alternative. PROSPERO REGISTRATION NUMBER CRD42021240099.
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Affiliation(s)
- Isma Qureshi
- Emergency Medicine, Hamad General Hospital, Doha, Qatar
| | - Khadiga Abdulrashid
- Public Health, Qatar University College of Health Sciences, Doha, Qatar
- Primary Health Care Corporation, Doha, Qatar
| | - Stephen H Thomas
- Emergency Medicine, Hamad General Hospital, Doha, Qatar
- Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
| | | | - Sameer A Pathan
- Emergency Medicine, Hamad General Hospital, Doha, Qatar
- Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
- School of Public health and Preventive medicine, Monash University, Melbourne, Victoria, Australia
| | - Tim Harris
- Emergency Medicine, Hamad General Hospital, Doha, Qatar
- Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
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Tian L, Liu Y, Xu X, Jiao P, Hu G, Cui Y, Chen J, Ma Y, Jin X, Wang K, Sun Q. Lactiplantibacillus plantarum J-15 reduced calcium oxalate kidney stones by regulating intestinal microbiota, metabolism, and inflammation in rats. FASEB J 2022; 36:e22340. [PMID: 35524736 DOI: 10.1096/fj.202101972rr] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/12/2022] [Accepted: 04/23/2022] [Indexed: 02/05/2023]
Abstract
The prevention role of Lactiplantibacillus plantarum against the formation of kidney stones has been increasingly recognized; its mechanism, however, has mainly been focused on inhibiting the inflammation in the colon in the gastrointestinal (GI) system, and the intestinal metabolites from microflora have not been revealed fully with regarding to the stone formation. In this study, we investigated the effect of L. plantarum J-15 on kidney stone formation in renal calcium oxalate (CaOx) rats induced by ethylene glycol and monitored the changes of intestinal microflora and their metabolites detected by 16S rRNA sequencing and widely targeted analysis, followed by the evaluation of the intestinal barrier function and inflammation levels in the colon, blood and kidney. The results showed that L. plantarum J-15 effectively reduced renal crystallization and urinary oxalic acid. Ten microbial genera, including anti-inflammatory and SCFAs-related Faecalibaculum, were enriched in the J-15 treatment group. There are 136 metabolites from 11 categories significantly different in the J-15 supplementation group compared with CaOx model rats, most of which were enriched in the amino acid metabolic and secondary bile acid pathways. The expression of intestinal tight junction protein Occludin and the concentration of pro-inflammatory cytokines and prostaglandin were decreased in the intestine, which further reduced the translocated lipopolysaccharide and inflammation levels in the blood upon J-15 treatment. Thus, the inflammation and injury in the kidney might be alleviated by downregulating TLR4/NF-κB/COX-2 signaling pathway. It suggested that L. plantarum J-15 might reduce kidney stone formation by restoring intestinal microflora and metabolic disorder, protecting intestinal barrier function, and alleviating inflammation. This finding provides new insights into the therapies for renal stones.
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Affiliation(s)
- Lei Tian
- Key Laboratory of Bio-Resource and Eco-Environment of the Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Yu Liu
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Xiaofang Xu
- Key Laboratory of Bio-Resource and Eco-Environment of the Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Pengrui Jiao
- Key Laboratory of Bio-Resource and Eco-Environment of the Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Gaofei Hu
- Key Laboratory of Bio-Resource and Eco-Environment of the Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Yaqian Cui
- Key Laboratory of Bio-Resource and Eco-Environment of the Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Jixiang Chen
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Yucheng Ma
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Xi Jin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Kunjie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Qun Sun
- Key Laboratory of Bio-Resource and Eco-Environment of the Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
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Parecoxib Vs Paracetamol for Treatment of Acute Renal Colic Due to Ureteric Calculi: A Randomized Controlled Trial. Urology 2020; 149:76-80. [PMID: 33373701 DOI: 10.1016/j.urology.2020.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/06/2020] [Accepted: 12/10/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To compare efficacy and safety of parecoxib and paracetamol for treatment of acute renal colic due to ureteric stones. MATERIALS AND METHODS A randomized, double blinded, controlled trial included adult patients presented to emergency department with acute renal colic due to ureteric calculi between June 2019 and August 2020. Patients with hypersensitivity to either drug, peptic ulcer, coronary ischemia, peripheral vascular or cerebrovascular disease, hepatic impairment (Child-Pugh score >10) or chronic kidney disease stage 4 or 5 were excluded. Eligible patients were randomized to group 1 who received 1g intravenous Paracetamol infusion or group 2 who received 40mg intravenous Parecoxib infusion. Pain analogue score was evaluated before treatment and 30 minutes afterwards. The primary endpoint was the need for rescue analgesia for persistent pain. Safety was evaluated by the incidence of adverse events. RESULTS The study included 203 patients (102 in group 1 and 101 in group 2). Pretreatment patients' data were comparable for both groups. The mean pain analogue score decrease from 7.6 to 3.8 in paracetamol group (P <.001) and from 7.8 to 3.4 in parecoxib group (P <.001). Rescue analgesia were needed in 36 patients (35.3%) in paracetamol group and 27 patients (26.7%) in parecoxib group (P = .187). Minor adverse events developed in 2 patients (2%) in paracetamol group and 3 patients (3%) in parecoxib group (P=0.683). CONCLUSION Paracetamol and Parecoxib were effective for treatment for patient with acute renal colic. Both treatments showed comparable results in reduction of pain and need for rescue analgesia with minimal adverse events.
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Comparing the analgesic effect of intravenous paracetamol with morphine on patients with renal colic pain: A meta-analysis of randomized controlled studies. Am J Emerg Med 2020; 38:1470-1474. [DOI: 10.1016/j.ajem.2020.03.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 12/20/2022] Open
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Chang AK, Bijur PE, Ata A, Campbell C, Pearlman S, White D, Chertoff A, Restivo A, Gallagher EJ. Randomized Clinical Trial of Intravenous Acetaminophen as an Analgesic Adjunct for Older Adults With Acute Severe Pain. Acad Emerg Med 2019; 26:402-409. [PMID: 30118582 DOI: 10.1111/acem.13556] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/06/2018] [Accepted: 08/13/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Older adults are at risk for undertreatment of pain. We examined intravenous (IV) acetaminophen as an analgesic adjunct to IV opioids in the care of older emergency department (ED) patients with acute severe pain. METHODS This was a randomized clinical trial conducted in two EDs in the Bronx, New York. Eligible adults aged 65 years and older with acute severe pain were randomized to 0.5 mg of IV hydromorphone and 1 g of IV acetaminophen or 0.5 mg of IV hydromorphone and 100 mL of normal saline placebo. The primary outcome was the between group difference in improvement of numerical rating scale (NRS) pain scores at 60 minutes. Secondary outcomes were the between-group differences in the proportion of patients who chose to forgo additional pain medications at 60 minutes; the proportion who developed side effects; the proportion who required rescue analgesia; and between-group differences in NRS pain scores at 5, 15, 30, and 45 minutes. RESULTS Eighty-one patients were allocated to each arm. Eighty patients in the IV acetaminophen arm and 79 patients in the placebo arm had sufficient data for analysis. At 60 minutes, patients in the hydromorphone + IV acetaminophen group improved by 5.7 NRS units while those in the hydromorphone + placebo group improved by 5.2 NRS units, for a difference of 0.6 NRS units (95% confidence interval [CI] = -0.4 to 1.5). A total of 28.7% of patients in the hydromorphone + IV acetaminophen group wanted more analgesia at 60 minutes versus 29.1% in the hydromorphone + placebo group, for a difference of -0.4% (95% CI = -14.3% to 13.5%). These differences were neither clinically nor statistically significant. Safety profiles were similar in both groups. CONCLUSION In this randomized clinical trial, the addition of IV acetaminophen to IV hydromorphone as an adjunctive analgesic for acute, severe, pain in older adults provided neither clinically nor statistically superior pain relief when compared to hydromorphone alone within the first hour of treatment.
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Affiliation(s)
- Andrew K. Chang
- Department of Emergency Medicine Albany Medical College AlbanyNY
| | - Polly E. Bijur
- Department of Emergency Medicine Albert Einstein College of Medicine Bronx NY
| | - Ashar Ata
- Department of Emergency Medicine Albany Medical College AlbanyNY
| | - Caron Campbell
- Department of Emergency Medicine Albert Einstein College of Medicine Bronx NY
| | - Scott Pearlman
- Department of Emergency Medicine Albert Einstein College of Medicine Bronx NY
| | - Deborah White
- Department of Emergency Medicine Albert Einstein College of Medicine Bronx NY
| | - Andrew Chertoff
- Department of Emergency Medicine Albert Einstein College of Medicine Bronx NY
| | - Andrew Restivo
- Department of Emergency Medicine Albert Einstein College of Medicine Bronx NY
| | - E. John Gallagher
- Department of Emergency Medicine Albert Einstein College of Medicine Bronx NY
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Oral Diclofenac Potassium Versus Intravenous Acetaminophen in Acute, Isolated, Closed-Limb Trauma. Adv Emerg Nurs J 2019; 41:48-55. [PMID: 30702534 DOI: 10.1097/tme.0000000000000224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pain control is an important concern in limb trauma. The most ideal agent for this purpose varies among different hospitals. The objective of this study was to compare the analgesic effect of oral diclofenac potassium versus intravenous acetaminophen in patients with limb trauma. This was a double-blind randomized clinical trial conducted on 60 adult patients. Oral diclofenac potassium (50 mg) was given in Group D, and intravenous acetaminophen (1 g in 500 ml normal saline over 20 min) was administered in Group A. Patients' pain scores (visual analogue scale) were recorded and compared at baseline, 5, 15, 30, 60 min, and 4 hr after drug administration. The mean age was 42.62 ± 15.42 and 38.04 ± 17.48 years in Group A and Group D, respectively. No significant change was observed between the 2 groups (p = 0.11). In this study, both drugs could decrease the pain score effectively and safely in isolated limb trauma.
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Randomized Controlled Trial of Intravenous Acetaminophen Versus Intravenous Hydromorphone for the Treatment of Acute Pain in the Emergency Department. Ann Emerg Med 2019; 73:133-140. [DOI: 10.1016/j.annemergmed.2018.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 05/30/2018] [Accepted: 06/11/2018] [Indexed: 12/13/2022]
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Paracetamol vs. Intravenous Morphine Plus Diclofenac in Renal Colic Pain: A Randomized Clinical Trial. Nephrourol Mon 2018. [DOI: 10.5812/numonthly.77193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Pathan SA, Mitra B, Cameron PA. A Systematic Review and Meta-analysis Comparing the Efficacy of Nonsteroidal Anti-inflammatory Drugs, Opioids, and Paracetamol in the Treatment of Acute Renal Colic. Eur Urol 2017; 73:583-595. [PMID: 29174580 DOI: 10.1016/j.eururo.2017.11.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/03/2017] [Indexed: 11/15/2022]
Abstract
CONTEXT Renal colic is a common, acute presentation of urolithiasis that requires immediate pain relief. European Association of Urology guidelines recommend nonsteroidal anti-inflammatory drugs (NSAIDs) as the preferred analgesia. However, the fear of NSAID adverse effects and the uncertainty about superior analgesic effect have maintained the practice of advocating intravenous opioids as the initial analgesia. OBJECTIVE The objective of this systematic review and meta-analysis was to compare the safety and efficacy of NSAIDs with opioids and paracetamol (acetaminophen) for the management of acute renal colic. EVIDENCE ACQUISITION Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, World Health Organization International Clinical Trials Registry Platform, Google Scholar, and the reference list of retrieved articles were searched up to December 2016 without language restrictions. Two reviewers independently assessed eligible studies using the Cochrane Collaboration tool for assessing and reporting the risk of bias and abstracted data using predefined data fields. EVIDENCE SYNTHESIS From 468 potentially relevant studies, 36 randomized controlled trials (RCTs) including 4887 patients, published between 1982 and 2016, were included in this systematic review. The treatment effect observed indicated marginal benefit of NSAIDs over opioids in initial pain reduction at 30min (11 RCTs, n=1985, mean difference [MD] -5.58, 95% confidence interval [CI] -10.22 to -0.95; heterogeneity I2=81%). In the subgroup analyses by the route of administration, NSAIDs required fewer rescue treatments (seven RCTs, n=541, number needed to treat [NNT] 11, 95% CI 6-75) and had lower vomiting rates compared with opioids (five RCTs, n=531, NNT 5, 95% CI 4-8). Comparisons of NSAIDs with paracetamol showed no difference for both drugs at 30min (four RCTs, n=1325, MD -5.67, 95% CI -17.52 to 6.18, p=0.35; I2=89%). Patients treated with NSAIDs required fewer rescue treatments (two trials, n=1145, risk ratio 0.56, 95% CI 0.42-0.74, p<0.001; I2=0%). CONCLUSIONS NSAIDs were equivalent to opioids or paracetamol in the relief of acute renal colic pain at 30min. There was less vomiting and fewer requirements for rescue analgesia with NSAIDs compared with opioids. Patients treated with NSAIDs required less rescue analgesia compared with paracetamol. Despite observed heterogeneity among the included studies and the overall quality of evidence, the findings of a lower need for rescue analgesia and fewer adverse events, in conjunction with the practical advantages of ease of delivery, suggest that NSAIDs should be the preferred analgesic option for patients presenting to the emergency department with renal colic. PATIENT SUMMARY In kidney stone-related acute pain episodes in patients with adequate renal function, treatment with nonsteroidal anti-inflammatory drugs offers effective and most sustained pain relief, with fewer side effects, when compared with opioids or paracetamol.
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Affiliation(s)
- Sameer A Pathan
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia.
| | - Biswadev Mitra
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia; Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | - Peter A Cameron
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia; Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
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Comparison of IV dexketoprofen trometamol, fentanyl, and paracetamol in the treatment of renal colic in the ED: A randomized controlled trial. Am J Emerg Med 2017; 36:571-576. [PMID: 29029797 DOI: 10.1016/j.ajem.2017.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/09/2017] [Accepted: 09/13/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE In this study, we aimed to compare the analgesic efficacy of intravenous dexketoprofen trometamol, fentanyl, and paracetamol in patients presenting to the emergency department with renal colic. MATERIALS AND METHOD Data obtained from the emergency departments of Gaziantep University's Hospital for Research and Practice along with two other state hospitals in Gaziantep, Turkey between January 2016 and January 2017 was used for this study. A total of three hundred patients (n=300), who presented to the ER with complaints most common to renal colic whose diagnoses were subsequently confirmed with Computerized Tomography were included in the study. Patients' pain scores were recorded using the Visual Analogue Scale, at admission (immediately before drug administration), then at the 15th, and 30th minutes. SPSS 22.0 software package was used for analysis. p<0.05 was considered significant. RESULTS At the 15th minute comparison, the efficacies of the three groups of drugs were not superior to one other, but at the 30th minute, dexketoprofen trometamol was statistically more effective than paracetamol and fentanyl. There was no statistically significant difference between fentanyl and paracetamol. The need for additional analgesia in the group receiving dexketoprofen trometamol was found to be lower. Dexketoprofen trometamol was statistically superior to the other two agents in achieving full analgesia at the end of the thirty-minute period. Fentanyl was found to be statistically significant in achieving moderate analgesia. CONCLUSION As a Non-steroidal antiinflammatory drug dexketoprofen trometamol is superior to paracetamol and fentanyl in achieving analgesia and reducing the need for additional drugs for the treatment of renal colic.
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Intravenous Acetaminophen for Renal Colic in the Emergency Department: Where Do We Stand? Am J Ther 2017; 24:e12-e19. [DOI: 10.1097/mjt.0000000000000526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bounes V, Vallé B, Concina F, Lauque D, Ducassé JL, Edlow JA. Treatment of Acute Renal Colic in US and French EDs: Simulated Cases and Real Cases in Acute Pain Management. Am J Emerg Med 2016; 34:1955-1958. [PMID: 27431741 DOI: 10.1016/j.ajem.2016.06.107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess the prescribing patterns in acute renal colic in emergency departments in US and France, by comparing physicians' intended prescription practices with actual prescription data in a sample of emergency practitioners. METHODS Pharmaco-epidemiological international study in two phases. First, we surveyed emergency physicians in US and France as to what analgesics they would use for simulated cases of renal colic. We then conducted a retrospective review of actual cases of emergency department patients with pain scores ≥6/10 with acute renal colic during a period of 6 months before the survey. We compared nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids used for pain treatment in the two groups, and the differences between the two countries. RESULTS One hundred six prescribers and 100 patients were included in the study. Comparison between simulated and real cases showed that NSAIDs and opioids were less frequently prescribed in real life (78% vs 99% and 51% vs 100% respectively). Morphine was the most prescribed opioid (96% of simulated cases and 34% of real ones). Acetaminophen use was increased in real life cases (58% vs 0%). Concerning the differences between countries, US physicians are more likely to administer morphine (64% vs 38%) and French physicians NSAIDs (88% vs 68%). The NSAIDs used are ketorolac in the United States (94% of simulated cases vs 64%) and ketoprofen in France (94% and 88% respectively). DISCUSSION We showed clear differences between intended and real analgesic prescription practices for patients suffering from renal colic. Some differences exist for pain perceptions and treatments between US and France.
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Affiliation(s)
- Vincent Bounes
- Pôle Médecine d'Urgence, Hôpital Universitaire de Purpan, Toulouse 31059, Cedex 9, France; Unité de Recherche de Pharmacoépidémiologie, INSERM UMR 1027 Toulouse, France.
| | - Baptiste Vallé
- Pôle Médecine d'Urgence, Hôpital Universitaire de Purpan, Toulouse 31059, Cedex 9, France
| | - François Concina
- Pôle Médecine d'Urgence, Hôpital Universitaire de Purpan, Toulouse 31059, Cedex 9, France
| | - Dominique Lauque
- Pôle Médecine d'Urgence, Hôpital Universitaire de Purpan, Toulouse 31059, Cedex 9, France
| | - Jean-Louis Ducassé
- Pôle Médecine d'Urgence, Hôpital Universitaire de Purpan, Toulouse 31059, Cedex 9, France
| | - Jonathan A Edlow
- Department of Emergency Medicine Administrative Offices, West CC-2, Beth Israel Deaconess Medical Center, 1 Deaconess Place, Boston, MA 02215, USA
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Pathan SA, Mitra B, Straney LD, Afzal MS, Anjum S, Shukla D, Morley K, Al Hilli SA, Al Rumaihi K, Thomas SH, Cameron PA. Delivering safe and effective analgesia for management of renal colic in the emergency department: a double-blind, multigroup, randomised controlled trial. Lancet 2016; 387:1999-2007. [PMID: 26993881 DOI: 10.1016/s0140-6736(16)00652-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The excruciating pain of patients with renal colic on presentation to the emergency department requires effective analgesia to be administered in the shortest possible time. Trials comparing intramuscular non-steroidal anti-inflammatory drugs with intravenous opioids or paracetamol have been inconclusive because of the challenges associated with concealment of randomisation, small sample size, differences in outcome measures, and inadequate masking of participants and assessors. We did this trial to develop definitive evidence regarding the choice of initial analgesia and route of administration in participants presenting with renal colic to the emergency department. METHODS In this three-treatment group, double-blind, randomised controlled trial, adult participants (aged 18-65 years) presenting to the emergency department of an academic, tertiary care hospital in Qatar, with moderate to severe renal colic (Numerical pain Rating Scale ≥ 4) were recruited. With the use of computer-generated block randomisation (block sizes of six and nine), participants were assigned (1:1:1) to receive diclofenac (75 mg/3 mL intramuscular), morphine (0.1 mg/kg intravenous), or paracetamol (1 g/100 mL intravenous). Participants, clinicians, and trial personnel were masked to treatment assignment. The primary outcome was the proportion of participants achieving at least a 50% reduction in initial pain score at 30 min after analgesia, assessed by intention-to-treat analysis and per-protocol analysis, which included patients where a calculus in the urinary tract was detected with imaging. This trial is registered with ClinicalTrials.gov, number NCT02187614. FINDINGS Between Aug 5, 2014, and March 15, 2015, we randomly assigned 1645 participants, of whom 1644 were included in the intention-to-treat analysis (547 in the diclofenac group, 548 in the paracetemol group, and 549 in the morphine group). Ureteric calculi were detected in 1316 patients, who were analysed as the per-protocol population (438 in the diclofenac group, 435 in the paracetemol group, and 443 in the morphine group). The primary outcome was achieved in 371 (68%) patients in the diclofenac group, 364 (66%) in the paracetamol group, and 335 (61%) in the morphine group in the intention-to-treat population. Compared to morphine, diclofenac was significantly more effective in achieving the primary outcome (odds ratio [OR] 1·35, 95% CI 1·05-1·73, p=0·0187), whereas no difference was detected in the effectiveness of morphine compared with intravenous paracetamol (1·26, 0·99-1·62, p=0·0629). In the per-protocol population, diclofenac (OR 1·49, 95% CI 1·13-1·97, p=0·0046) and paracetamol (1·40, 1·06-1·85, p=0·0166) were more effective than morphine in achieving the primary outcome. Acute adverse events in the morphine group occurred in 19 (3%) participants. Significantly lower numbers of adverse events were recorded in the diclofenac group (7 [1%] participants, OR 0·31, 95% CI 0·12-0·78, p=0·0088) and paracetamol group (7 [1%] participants, 0·36, 0·15-0·87, p=0·0175) than in the morphine group. During the 2 week follow-up, no additional adverse events were noted in any group. INTERPRETATION Intramuscular non-steroidal anti-inflammatory drugs offer the most effective sustained analgesia for renal colic in the emergency department and seem to have fewer side-effects. FUNDING Hamad Medical Corporation Medical Research Center, Doha, Qatar.
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Affiliation(s)
- Sameer A Pathan
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia.
| | - Biswadev Mitra
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia; Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
| | - Lahn D Straney
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
| | - Muhammad Shuaib Afzal
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Shahzad Anjum
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Dharmesh Shukla
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Kostantinos Morley
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Shatha A Al Hilli
- Emergency Radiology Section-Radiology Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khalid Al Rumaihi
- Department of Urology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Stephen H Thomas
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Peter A Cameron
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia; Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
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Sin B, Wai M, Tatunchak T, Motov SM. The Use of Intravenous Acetaminophen for Acute Pain in the Emergency Department. Acad Emerg Med 2016; 23:543-53. [PMID: 26824905 DOI: 10.1111/acem.12921] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 12/02/2015] [Accepted: 12/03/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Acetaminophen (APAP) is a mainstay for pain management worldwide. The intravenous (IV) formulation has been widely used in Europe for more than 20 years in adults and children. In the United States, IV APAP obtained full approval from the Food and Drug Administration in 2010. There is emerging literature to suggest the use of IV APAP for pain reduction in the emergency department (ED). This evidence-based review examines the evidence pertaining to the use of IV APAP for acute pain control in the ED. METHODS The MEDLINE and EMBASE databases were searched. Randomized controlled trials (RCTs) that described or evaluated the use of IV APAP for acute pain in the ED were included. Duplicate articles, unpublished reports, abstracts, review articles, and non-English literature were excluded. The primary outcome of interest in this review was the difference in pain score between IV APAP and active comparator or placebo from baseline to a cutoff time specified in the original trials. Secondary outcome measures were the incidence of adverse events and reduction in the amount of adjuvant analgesics consumed by patients who received IV APAP. Methodologic quality of the trials was assessed using the Grading of Recommendations Assessment, Development, and Evaluation criteria. RESULTS Fourteen RCTs with various methodologic flaws, which enrolled a total of 1,472 patients, met the inclusion criteria. The level of evidence for the individual trials ranged from very low to moderate. In three of the 14 trials, a significant reduction in pain scores was observed in patients who received IV APAP. The first trial found a significant reduction in mean pain scores when IV APAP was compared to IV morphine at 30 minutes after drug administration (4.7 ± 2.3 vs. 2.9 ± 2.2). In the second trial, patients who received IV APAP reported of lower pain scores (31.7 ± 18 mm, 95% confidence interval [CI] = 8.2 to 25.2 mm) compared to those who received IV morphine (48.3 ± 14.1 mm, 95% CI = 8.2 to 25.2 mm), 15 minutes after drug administration. A third trial found a significant reduction (p = 0.005) in the mean pain scores when IV APAP was compared to intramuscular piroxicam at 90 minutes after drug administration. In the remaining eight trials, pain scores were not statistically different when IV APAP was compared to other pain medications. The incidence of side effects associated with IV APAP was very low. CONCLUSIONS Fourteen RCTs with various methodologic flaws provided limited evidence to support the use of IV APAP as the primary analgesic for acute pain control in patients who present to the ED.
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Affiliation(s)
- Billy Sin
- The Arnold & Marie Schwartz College of Pharmacy; Long Island University; Brooklyn NY
- The Department of Pharmacy; Division of Pharmacotherapy Services; Emergency Department Clinical Research Program; Department of Emergency Medicine; The Brooklyn Hospital Center; Brooklyn NY
| | - Mabel Wai
- Yale New Haven Hospital; New Haven CT
| | - Tamara Tatunchak
- The Department of Pharmacy; Division of Pharmacotherapy Services; Emergency Department Clinical Research Program; Department of Emergency Medicine; The Brooklyn Hospital Center; Brooklyn NY
| | - Sergey M. Motov
- The Department of Emergency Medicine; Maimonides Medical Center; Brooklyn NY
- The SUNY Downstate Medical Center; Brooklyn NY
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Morphine Suppository versus Indomethacin Suppository in the Management of Renal Colic: Randomized Clinical Trial. PAIN RESEARCH AND TREATMENT 2016; 2016:4981585. [PMID: 27073696 PMCID: PMC4814695 DOI: 10.1155/2016/4981585] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 02/11/2016] [Accepted: 02/24/2016] [Indexed: 11/24/2022]
Abstract
Background. Renal colic is a medical emergency due to the rapid onset and devastating nature of its pain. Opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) are both used as first-line choices in its management. Aim. This study aimed to compare the efficacy and safety of opioids and NSAIDs in the management of acute renal colic. Methods. One hundred and fifty-eight patients were divided into two groups (n = 79) and received either 10 mg morphine or 100 mg indomethacin suppositories. The severity of pain was measured using verbal numeric rating scale at baseline and 20, 40, 60, and 90 minutes after the administration of analgesics. Drug side effects as well as patients' vital signs were also recorded. Results. The mean decrease in the pain score during the first 20 minutes was significantly higher among those who received morphine suppository. However, no significant difference was observed between the two groups regarding the mean decrease in pain score during the first 40, 60, and 90 minutes after the admission. Prevalence of drug side effects or changes in the vital signs was not significantly different between the two groups. Conclusions. Morphine suppositories seem to be more efficient in achieving rapid pain relief comparing to indomethacin.
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Jalili M, Mozaffarpour Noori A, Sedaghat M, Safaie A. Efficacy of Intravenous Paracetamol Versus Intravenous Morphine in Acute Limb Trauma. Trauma Mon 2016; 21:e19649. [PMID: 27218042 PMCID: PMC4869432 DOI: 10.5812/traumamon.19649] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 07/23/2014] [Accepted: 08/23/2014] [Indexed: 11/16/2022] Open
Abstract
Background: Efficient pain management is one of the most important components of care in the field of emergency medicine. Objectives: This study was conducted to compare intravenous paracetamol and intravenous morphine sulfate for acute pain reduction in patients with limb trauma. Patients and Methods: In a randomized double-blinded clinical trial, all patients (aged 18 years and older) with acute limb trauma and a pain score of greater than 3/10 in the emergency department were recruited; they received either 1 g intravenous paracetamol or 0.1 mg/kg intravenous morphine sulfate over 15 minutes. The primary outcome was the pain score measured on a numerical rating scale at 0, 15 and 30 minutes after commencing drug administration. The requirement for rescue analgesia and the frequency of adverse reactions were also recorded. Results: Sixty patients randomly received either IV paracetamol (n = 30) or IV morphine (n = 30). The mean reduction in numerical rating scale pain intensity scores at 30 minutes was 3.86 (± 1.61) for paracetamol, and 2.16 (± 1.39) for morphine. However, pain relief was significantly higher in the paracetamol group compared to the morphine group (P < 0.001). Four patients in the paracetamol group and 15 patients in the morphine group needed rescue analgesia and the difference was significant (P = 0.05). Conclusions: Intravenous paracetamol appears to provide better analgesia than intravenous morphine in acute limb trauma. Further larger studies are required.
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Affiliation(s)
- Mohammad Jalili
- Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mohammad Jalili, Department of Emergency Medicine, Imam Hospital, Keshavarz Boulevard, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9125483998, Fax: +98-2166904848, E-mail:
| | - Ali Mozaffarpour Noori
- Department of Emergency Medicine, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Mojtaba Sedaghat
- Department of Community Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Arash Safaie
- Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
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Irmak Sapmaz H, Uysal M, Taş U, Esen M, Barut M, Somuk BT, Alatlı T, Ayan S. The Effect of Lavender Oil in Patients with Renal Colic: A Prospective Controlled Study Using Objective and Subjective Outcome Measurements. J Altern Complement Med 2015. [PMID: 26222759 DOI: 10.1089/acm.2015.0112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To assess the usability of lavender oil as an adjuvant in the medical treatment of pain due to renal stones. METHODS One hundred patients age 19-64 years diagnosed with renal colic were included in the study. Group 1 (n=50) received standard medical therapy (diclofenac sodium, 75 mg intramuscularly); group 2 (n=50) received aromatherapy (lavender oil) in addition to the standard medical treatment. In both groups, the severity of the pain was graded between 0 (no pain) and 10 (severe pain) by using the visual analogue scale (VAS). RESULTS The VAS values at the beginning and at 10 and 30 minutes in group 1 were 7.70±1.61, 5.02±2.20, and 2.89±1.96, respectively; in group 2, the values were 7.83±2.02, 4.42±2.46, and 2.20±1.74, respectively. The VAS values for the male patients in group 1 at the beginning and at 10 and 30 minutes were 7.61±1.47, 4.80±2.00, and 2.67±1.74; in the female patients, the values were 7.81±1.80, 5.40±2.41, and 3.72±1.94. For the male patients in group 2, the VAS values at the beginning and at 10 and 30 minutes were 8.25±2.01, 4.93±2.72, and 2.96±1.90, respectively; for the female patients, the values were 7.52±1.94, 4.15±1.95, and 1.21±0.91, respectively. Results are presented as mean±SD. Although there was no significant difference between the VAS values at the beginning and at 10 minutes in both groups, the VAS values at 30 minutes in the group receiving aromatherapy plus conventional treatment were statistically significantly low. CONCLUSION These findings suggest that the use of aromatherapy, which is a nonpharmacologic treatment method, as an adjuvant to conventional treatment methods will help decrease pain, particularly in female patients.
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Affiliation(s)
- Hilal Irmak Sapmaz
- 1 Faculty of Medicine, Department of Anatomy, Gaziosmanpasa University , Tokat, Turkey
| | - Murat Uysal
- 1 Faculty of Medicine, Department of Anatomy, Gaziosmanpasa University , Tokat, Turkey
| | - Ufuk Taş
- 1 Faculty of Medicine, Department of Anatomy, Gaziosmanpasa University , Tokat, Turkey
| | - Mehmet Esen
- 2 Faculty of Medicine, Department of Emergency Medicine, Gaziosmanpasa University , Tokat, Turkey
| | - Mustafa Barut
- 3 Clinic of Internal Medicine, Tokat State Hospital , Tokat, Turkey
| | - Battal Tahsin Somuk
- 4 Faculty of Medicine, Department of Ear, Nose and Throat Diseases, Gaziosmanpasa University , Tokat, Turkey
| | - Tufan Alatlı
- 2 Faculty of Medicine, Department of Emergency Medicine, Gaziosmanpasa University , Tokat, Turkey
| | - Safiye Ayan
- 5 Faculty of Medicine, Department of Biochemistry, Gaziosmanpasa University , Tokat, Turkey
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Afshar K, Jafari S, Marks AJ, Eftekhari A, MacNeily AE. Nonsteroidal anti-inflammatory drugs (NSAIDs) and non-opioids for acute renal colic. Cochrane Database Syst Rev 2015; 2015:CD006027. [PMID: 26120804 PMCID: PMC10981792 DOI: 10.1002/14651858.cd006027.pub2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Renal colic is acute pain caused by urinary stones. The prevalence of urinary stones is between 10% and 15% in the United States, making renal colic one of the common reasons for urgent urological care. The pain is usually severe and the first step in the management is adequate analgesia. Many different classes of medications have been used in this regard including non-steroidal anti-inflammatory drugs and narcotics. OBJECTIVES The aim of this review was to assess benefits and harms of different NSAIDs and non-opioids in the treatment of adult patients with acute renal colic and if possible to determine which medication (or class of medications) are more appropriate for this purpose. Clinically relevant outcomes such as efficacy of pain relief, time to pain relief, recurrence of pain, need for rescue medication and side effects were explored. SEARCH METHODS We searched the Cochrane Renal Group's Specialised Register (to 27 November 2014) through contact with the Trials' Search Co-ordinator using search terms relevant to this review. SELECTION CRITERIA Only randomised or quasi randomised studies were included. Other inclusion criteria included adult patients with a clinical diagnosis of renal colic due to urolithiasis, at least one treatment arm included a non-narcotic analgesic compared to placebo or another non-narcotic drug, and reporting of pain outcome or medication adverse effect. Patient-rated pain by a validated tool, time to relief, need for rescue medication and pain recurrence constituted the outcomes of interest. Any adverse effects (minor or major) reported in the studies were included. DATA COLLECTION AND ANALYSIS Abstracts were reviewed by at least two authors independently. Papers meeting the inclusion criteria were fully reviewed and relevant data were recorded in a standardized Cochrane Renal Group data collection form. For dichotomous outcomes relative risks and 95% confidence intervals were calculated. For continuous outcomes the weighted mean difference was estimated. Both fixed and random models were used for meta-analysis. We assessed the analgesic effects using four different outcome variables: patient-reported pain relief using a visual analogue scale (VAS); proportion of patients with at least 50% reduction in pain; need for rescue medication; and pain recurrence. Heterogeneity was assessed using the I² test. MAIN RESULTS A total of 50 studies (5734 participants) were included in this review and 37 studies (4483 participants) contributed to our meta-analyses. Selection bias was low in 34% of the studies or unclear in 66%; performance bias was low in 74%, high in 14% and unclear in 12%; attrition bias was low in 82% and high in 18%; selective reporting bias low in 92% of the studies; and other biases (industry funding) was high in 4%, unclear in 18% and low in 78%.Patient-reported pain (VAS) results varied widely with high heterogeneity observed. For those comparisons which could be pooled we observed the following: NSAIDs significantly reduced pain compared to antispasmodics (5 studies, 303 participants: MD -12.97, 95% CI -21.80 to - 4.14; I² = 74%) and combination therapy of NSAIDs plus antispasmodics was significantly more effective in pain control than NSAID alone (2 studies, 310 participants: MD -1.99, 95% CI -2.58 to -1.40; I² = 0%).NSAIDs were significantly more effective than placebo in reducing pain by 50% within the first hour (3 studies, 197 participants: RR 2.28, 95% CI 1.47 to 3.51; I² = 15%). Indomethacin was found to be less effective than other NSAIDs (4 studies, 412 participants: RR 1.27, 95% CI 1.01 to 1.60; I² = 55%). NSAIDs were significantly more effective than hyoscine in pain reduction (5 comparisons, 196 participants: RR 2.44, 95% CI 1.61 to 3.70; I² = 28%). The combination of NSAIDs and antispasmodics was not superior to NSAIDs only (9 comparisons, 906 participants: RR 1.00, 95% CI 0.89 to 1.13; I² = 59%). The results were mixed when NSAIDs were compared to other non-opioid medications.When the need for rescue medication was evaluated, Patients receiving NSAIDs were significantly less likely to require rescue medicine than those receiving placebo (4 comparisons, 180 participants: RR 0.35, 95% CI 0.20 to 0.60; I² = 24%) and NSAIDs were more effective than antispasmodics (4 studies, 299 participants: RR 0.34, 95% CI 0.14 to 0.84; I² = 65%). Combination of NSAIDs and antispasmodics was not superior to NSAIDs (7 comparisons, 589 participants: RR 0.99, 95% CI 0.62 to 1.57; I² = 10%). Indomethacin was less effective than other NSAIDs (4 studies, 517 participants: RR 1.36, 95% CI 0.96 to 1.94; I² = 14%) except for lysine acetyl salicylate (RR 0.15, 95% CI 0.04 to 0.65).Pain recurrence was reported by only three studies which could not be pooled: a higher proportion of patients treated with 75 mg diclofenac (IM) showed pain recurrence in the first 24 hours of follow-up compared to those treated with 40 mg piroxicam (IM) (60 participants: RR 0.05, 95% CI 0.00 to 0.81); no significant difference in pain recurrence at 72 hours was observed between piroxicam plus phloroglucinol and piroxicam plus placebo groups (253 participants: RR 2.52, 95% CI 0.15 to12.75); and there was no significant difference in pain recurrence within 72 hours of discharge between IM piroxicam and IV paracetamol (82 participants: RR 1.00, 95% CI 0.65 to 1.54).Side effects were presented inconsistently, but no major events were reported. AUTHORS' CONCLUSIONS Although due to variability in studies (inclusion criteria, outcome variables and interventions) and the evidence is not of highest quality, we still believe that NSAIDs are an effective treatment for renal colic when compared to placebo or antispasmodics. The addition of antispasmodics to NSAIDS does not result in better pain control. Data on other types of non-opioid, non-NSAID medication was scarce.Major adverse effects are not reported in the literature for the use of NSAIDs for treatment of renal colic.
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Affiliation(s)
- Kourosh Afshar
- University of British Columbia, British Columbia's Children's HospitalDepartment of UrologyChildren's Ambulatory Care Building, Urology ClinicK0‐134, 4480 Oak StreetVancouverBCCanadaV6H 3V4
| | - Siavash Jafari
- University of British ColumbiaSchool of Population and Public Health5804 Fairview AveVancouverBCCanadaV6T 1Z3
| | - Andrew J Marks
- University of British ColumbiaDepartment of UrologyVancouverBCCanada
| | | | - Andrew E MacNeily
- University of British ColumbiaDepartment of UrologyVancouverBCCanada
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Kaynar M, Koyuncu F, Buldu İ, Tekinarslan E, Tepeler A, Karatağ T, İstanbulluoğlu MO, Ceylan K. Comparison of the efficacy of diclofenac, acupuncture, and acetaminophen in the treatment of renal colic. Am J Emerg Med 2015; 33:749-53. [DOI: 10.1016/j.ajem.2015.02.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/18/2015] [Accepted: 02/19/2015] [Indexed: 11/15/2022] Open
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20
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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. [PMID: 25197573 PMCID: PMC4147290 DOI: 10.1155/2014/571326] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 08/01/2014] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to compare the clinical efficacy of intravenous acetaminophen with intravenous morphine in acute renal colic pain management. In this double-blind controlled trial, patients aged 18–55 years, diagnosed with acute renal colic, who met the inclusion and exclusion criteria, were randomized into two groups. First, using the visual analogue scale (VAS), intensity of pain was assessed in both groups. Then, one gram of intravenous acetaminophen or 0.1 mg/kg morphine was infused in 100 mL normal saline to either acetaminophen or morphine group. Intensity of pain was reassessed in 15, 30, 45, and 60 minutes according to VAS criteria. Finally, data from 108 patients were analyzed, 54 patients in each group. No significant difference was observed between the two groups in regard to sex (P = 0.13), mean age (P = 0.54), and baseline visual analogue score (P = 0.21). A repeated measure analysis of variance revealed that the difference between the two treatments was significant (P = 0.0001). The VAS reduction at primary endpoint (30 min after drug administration) was significantly higher in the acetaminophen group than in the morphine group (P = 0.0001). This study demonstrated that intravenous acetaminophen could be more effective than intravenous morphine in acute renal colic patients' pain relief.
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Abstract
Paracetamol has become a focus of attention as being unsafe due to hepatic toxicity and market withdrawal or prescription status is presently under discussion in Germany. This drug is, however, effective and safe if notes of caution are applied. In Germany 38 fatal cases of analgesic poisoning were observed in 2010, only 4 of which were due to paracetamol and 16 were caused by diclofenac and ibuprofen. Alternative pain medications are obviously much less safe, in particular given the additional risk of sometimes fatal gastrointestinal bleeding and cardiovascular side effects. This review extensively analyzes the safety record of paracetamol and applies these findings to the treatment of elderly people. Even very elderly patients may be safely treated with this compound, although a dose limit of 3 g/day should be instituted. This renewed discussion was triggered by the uncontrolled availability of paracetamol in the USA but observations from this country should not be generalized and applied to the German situation and objective reasoning should be re-installed.
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Affiliation(s)
- M Wehling
- Klinische Pharmakologie Mannheim, Zentrum für Gerontopharmakologie, Medizinische Fakultät Mannheim, Universität Heidelberg, Maybachstr. 14, 68169, Mannheim, Deutschland.
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Golzari SEJ, Soleimanpour H, Rahmani F, Zamani Mehr N, Safari S, Heshmat Y, Ebrahimi Bakhtavar H. Therapeutic approaches for renal colic in the emergency department: a review article. Anesth Pain Med 2014; 4:e16222. [PMID: 24701420 PMCID: PMC3961032 DOI: 10.5812/aapm.16222] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 12/08/2013] [Accepted: 12/16/2013] [Indexed: 12/21/2022] Open
Abstract
Context: Renal colic is frequently described as the worst pain ever experienced, and management of this intense pain is necessary. The object of our review was to discuss different approaches of pain control for patients with acute renal colic in the emergency department. Evidence Acquisition: Studies that discussed the treatment of renal colic pain were included in this review. We collected articles from reputable internet databases. Results: Our study showed that some new treatment approaches, such as the use of lidocaine or nerve blocks, can be used to control the severe and persistent pain of renal colic. Conclusions: Some new approaches are discussed and their impact on renal colic pain control was compared with traditional therapies. The effectiveness of the new approaches in this review is similar or even better than in traditional treatments.
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Affiliation(s)
- Samad EJ Golzari
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Soleimanpour
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Corresponding author: Hassan Soleimanpour, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Tel: +989141164134, Fax: +984113352078, E-mail:
| | - Farzad Rahmani
- Emergency Medicine Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nahid Zamani Mehr
- Students Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeid Safari
- Anesthesiology and Critical Care Department, Iran University of Medical Sciences, Tehran, Iran
| | - Yaghoub Heshmat
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Eken C, Serinken M, Elicabuk H, Uyanik E, Erdal M. Intravenous paracetamol versus dexketoprofen versus morphine in acute mechanical low back pain in the emergency department: a randomised double-blind controlled trial. Emerg Med J 2013; 31:177-81. [PMID: 23407378 DOI: 10.1136/emermed-2012-201670] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
STUDY OBJECTIVE The objective of this study was to determine the analgesic efficacy and safety of intravenous, single-dose paracetamol versus dexketoprofen versus morphine in patients presenting with mechanical low back pain (LBP) to the emergency department (ED). METHODS This randomised double-blind study compared the efficacy of intravenous 1 gm paracetamol, 50 mg dexketoprofen and 0.1 mg/kg morphine in patients with acute mechanical LBP. Visual analogue scale (VAS) was used for pain measurement at baseline, after 15 and after 30 min. RESULTS A total of 874 patients were eligible for the study, and 137 of them were included in the final analysis: 46 patients from the paracetamol group, 46 patients in the dexketoprofen group and 45 patients in the morphine group. The mean age of study subjects was 31.5 ± 9.5 years, and 60.6% (n=83) of them were men. The median reduction in VAS score at the 30th minute for the paracetamol group was 65 mm (95% CI 58 to 72), 67 mm (95% CI 60 to 73) for the morphine group and 58 mm (95% CI 50 to 64) for the dexketoprophen group. Although morphine was not superior to paracetamol at 30 min (difference: 3.8 ± 4.9 (95% CI -6 to 14), the difference between morphine and dexketoprofen in reducing pain was 11.2 ± 4.7 (95% CI 2 to 21). At least one adverse effect occurred in 8.7% (n=4) of the cases in the paracetamol group, 15.5% (n=7) of the morphine group, and 8.7% (n=4) of the dexketoprophen group (p=0.482). CONCLUSIONS Intravenous paracetamol, dexketoprofen and morphine are not superior to each other for the treatment of mechanical LBP in ED.
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Affiliation(s)
- Cenker Eken
- Akdeniz University Medical Faculty, Department of Emergency Medicine, Antalya, Turkey
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24
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Ayan M, Tas U, Sogut E, Suren M, Gurbuzler L, Koyuncu F. Investigating the effect of aromatherapy in patients with renal colic. J Altern Complement Med 2012; 19:329-33. [PMID: 23072267 DOI: 10.1089/acm.2011.0941] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
AIM The aim of the present study was to investigate the usefulness of rose essential oil as a supplementary and adjunctive therapy for the relief of renal colic, specifically because rose essential oil is soothing and can act as a muscle relaxant. MATERIALS Eighty patients who were diagnosed with renal colic in the emergency room were included in the study, with ages ranging from 19 to 64 years. Half of the patients (n=40) were treated with conventional therapy (diclofenac sodium, 75 mg intramuscularly) plus placebo (physiological serum, 0.9% NaCl), while the other half (n=40) were given aromatherapy (rose essential oil) in addition to conventional therapy. In each patient, the severity of pain was evaluated using the Visual Analog Scale (VAS) (0 [no pain] to 10 [very severe pain]). FINDINGS The VAS values prior to the start of therapy, and 10 and 30 minutes after therapy were 8.18 ± 1.36, 5.60 ± 2.02, and 3.75 ± 2.08 for the conventional therapy plus placebo group, while for the conventional therapy plus aromatherapy group, the VAS values were 8.63 ± 1.03, 4.25 ± 1.72, and 1.08 ± 1.07, respectively. There was no statistically significant difference between the starting VAS values of the two groups, but the VAS values 10 or 30 minutes after the initiation of therapy were statistically lower in the group that received conventional therapy plus aromatherapy. CONCLUSION This study demonstrated that rose essential oil therapy in addition to conventional therapy effectively reduces renal colic pain.
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Affiliation(s)
- Murat Ayan
- Department of Emergency Medicine, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey.
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Abstract
Intravenous acetaminophen received United States Food and Drug Administration approval in November 2010 for the management of mild-to-moderate pain, management of moderate-to-severe pain with adjunctive opioid analgesics, and reduction of fever. Although intravenous acetaminophen generally improved pain relief and demonstrated opioid-sparing effects compared with placebo, it did not consistently reduce the frequency of opioid-related adverse events (e.g., postoperative nausea and vomiting). The safety and efficacy of intravenous acetaminophen as an antipyretic agent have been documented in adults and children; however, its cost is several-fold higher than that of the oral and rectal formulations. Although use of intravenous acetaminophen has reduced other postoperative resource utilization (e.g., hospital length of stay) in some studies outside the United States in patients undergoing abdominal surgery, a full economic evaluation in the United States has yet to be undertaken. In addition, its administration time (15-min infusion) and packaging (glass, single-use vial) have the potential to adversely affect patient flow in the postanesthesia care unit, create burden on patient care units, and lead to drug waste. Furthermore, 1 g of intravenous acetaminophen is formulated in 100 ml of solution, which may be an issue for patients with fluid restrictions. Given the clinical and economic evidence currently available, intravenous acetaminophen should not replace oral or rectal acetaminophen, but its use may be considered in a limited number of patients who cannot receive drugs orally and rectally and who cannot tolerate other parenteral nonopioid analgesic or antipyretic agents.
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Affiliation(s)
- Yu-Chen Yeh
- Center for Drug Policy, Partners Healthcare, 115 Fourth Avenue, Needham, MA 02494, USA.
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Ayan M, Sogut E, Tas U, Erdemir F, Sahin M, Suren M, Kaya Z, Demirturk F. Pain levels associated with renal colic and primary dysmenorrhea: a prospective controlled study with objective and subjective outcomes. Arch Gynecol Obstet 2012; 286:403-9. [DOI: 10.1007/s00404-012-2316-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Accepted: 03/22/2012] [Indexed: 01/20/2023]
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