Combination of intravenous morphine and paracetamol or intravenous morphine and dexketoprofen in treatment of acute renal colic: An optimum treatment approach in the emergency department

Combination of Intravenous Morphine and Paracetamol or Intravenous Morphine and Dexketoprofen in Treatment of Acute Renal Colic: An Optimum Treatment Approach in The Emergency Department Objective This randomized trial evaluated the analgesic efficacy and safety of intravenous morphine-paracetamol combination and morphine-dexketoprofen combination for the optimum treatment of renal colic. Methods We conducted a randomized, double-blind clinical trial comparing of intravenous morphine-paracetamol combination and morphine-dexketoprofen combination for patients presented to the emergency department with suspected renal colic. Subjects with inadequate pain relief at 30 minutes received rescue fentanyl (0.75 μg/kg). We compared changes in pain intensity 30 minutes after treatment among the three arms, as well as the need for rescue medication and the presence of adverse effects. Results 176 eligible patients were included in the study. 26 of the patients were excluded from the study. 14 of the patients who were included were not analyzed. The reasons for the patients not being included in the analysis were: 9 patients did not have nephrolithiasis, 3 patients were not within the age range, 1 patient had appendicitis, 1 patient had varicocele. In the end, 44 patients were included in dexketoprofen-morphine group, 46 patients were included in paracetamol-morphine group and 46 patients in morphine group. The decrease in GAS scores at the 60 minutes and 90 minutes were the primary endpoint of our study and were from 71,8 (64,8-78,8) to 72,2 (63,4-81,0), from 60,2 (53,5-66,8) to 64,0 (56,8-71,3), from 63,2 (53,9-72,5) to 68,0 (58,6-77,4) in morphineparacetamol group, morphine-dexketoprofen group, morphine group respectively. 31 The results were not statistically significant (p>0,05). 52 patients of total (% 38,2) needed rescue drug at 30 minutes. Of these patients 11 were in dexketoprofenmorphine group, 20 were in acetaminophen-morphine group and 21 were in morphine group (p=0,0876). There were no serious adverse events. Conclusion Combination of intravenous paracetamol and morphine is an efficacious and safe optimum treatment for emergency department patients with renal colic.