Comparing the analgesic efficacy of morphine plus ketamine versus morphine plus placebo in patients with acute renal colic: A double-blinded randomized controlled trial

Hosseininejad, Seyed Mohammad; Jahanian, Fatemeh; Irankar, Salman Erfanian; Moosazadeh, Mahmood; Hosseini, Seyed Adel; Shahbakhti, Niloufar; Bozorgi, Farzad

doi:10.1016/j.ajem.2018.09.004

Cited by 10 publications

(11 citation statements)

References 17 publications

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“…EMS: 1 RCT (41) found mean difference in the change of pain scores to be MD À1 (À2.2 to 0.2) at 30 min. ED: Meta-analysis of 4 RCT (42,43,45,46) found MD À0.59 (À2.24 to 1.06).…”

Section: Low (Medium Study Limitations Unknown Consistency)mentioning

confidence: 99%

Comparative Effectiveness of Analgesics to Reduce Acute Pain in the Prehospital Setting

Sobieraj

Martinez

Miao³

et al. 2019

Prehospital Emergency Care

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Objectives: The objectives of this study were to assess comparative effectiveness and harms of opioid and nonopioid analgesics for the treatment of moderate to severe acute pain in the prehospital setting. Methods: We searched MEDLINE V R , Embase V R , and Cochrane Central from the earliest date through May 9, 2019. Two investigators screened abstracts, reviewed full-text files, abstracted data, and assessed study level risk of bias. We performed meta-analyses when appropriate. Conclusions were made with consideration of established clinically important differences and we graded each conclusion's strength of evidence (SOE). Results: We included 52 randomized controlled trials and 13 observational studies. Due to the absence or insufficiency of prehospital evidence we based conclusions for initial analgesia on indirect evidence from the emergency department setting. As

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“…EMS: 1 RCT (41) found mean difference in the change of pain scores to be MD À1 (À2.2 to 0.2) at 30 min. ED: Meta-analysis of 4 RCT (42,43,45,46) found MD À0.59 (À2.24 to 1.06).…”

Section: Low (Medium Study Limitations Unknown Consistency)mentioning

confidence: 99%

Comparative Effectiveness of Analgesics to Reduce Acute Pain in the Prehospital Setting

Sobieraj

Martinez

Miao³

et al. 2019

Prehospital Emergency Care

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“…Gottlieb & Nakitende (7) tras un metaanálisis que incluyo 1 1316 pacientes demostraron que no existía una disminución estadísticamente significativa tanto en escala de dolor como en número de días con analgésicos al comparar Tamsulosina oral vs nifedipina vs placebo. (13), tras analizar la eficacia de Morfina + solución salina isotónica versus morfina + ketamina en 200 pacientes demostraron que la adición de 0,2 mg/kg de ketamina a 0,1 mg/kg de morfina puede reducir el dolor de cólico renal, náuseas y vómitos más que la morfina sola; sin embargo, se asoció con un mayor número de pacientes con mareos. Finalmente Maleki, Porozan et al (14), tras analizar la eficacia de Ketorolaco + solución salina isotónica como placebo versus ketorolaco + sulfato de magnesio en 87 pacientes, demostraron que el sulfato de magnesio no influyó en el alivio del dolor de cólicos renales.…”

Section: Resultsunclassified

Tratamiento farmacológico analgésico del cólico nefrítico

Moya¹,

Zambrano²,

Espinal³

et al. 2023

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Introducción: El cólico nefrítico es un episodio doloroso de gran intensidad e inicio agudo, que tras ceder puede experimentar recidivas intermitentes, frecuentemente asociado a nefrolitiasis, siendo los fármacos analgésicos empleados para el manejo en estos pacientes. Objetivo: Comparar la eficacia de los tratamientos farmacológicos analgésicos más empleados en el abordaje del cólico nefrítico por nefrolitiasis. Métodos: Se realizó una búsqueda sistemática de la literatura en PubMed, ScienceDirect, Redalyc y LILACS, empleando el algoritmo de búsqueda como "pain"[MeSH Terms] OR "pain"[All Fields]) AND ("nephrolithiasis"[MeSH Terms]. Se obtuvieron un total de 65 potenciales resultados, para luego limitar el estudio a 12 artículos en base al criterio de número de participantes previamente expuesto, y la disponibilidad del texto completo de forma gratuita. Resultados: Entre los fármacos analgésico-empleados para el cólico nefrítico por nefrolitiasis se demostró que el efecto de AINES, la lidocaína intravenosa, hidromorfina, incluso combinaciones como Ketorolaco + solución salina isotónica pueden controlar el dolor abdominal general y dolor por nefrolitiasis. Conclusiones: Entre los estudios incluidos se obtuvo que el Ibuprofeno IV y el diclofenaco IM son más eficaces incluso que el paracetamol IV o la morfina IV, mostrando mayor ventaja la administración de diclofenaco para del dolor por cólico nefrítico y siendo a su vez preferido por los pacientes.

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“… 17 44 45 A total of 903 patients were randomised to treatment arms; of which 897 patients were included in formal analyses (69.1% were male; 485 were assigned to intervention and 412 to control). Sample sizes ranged from 60 44 45 to 200 42 patients. Five studies reported the mean age of patients ranging from 31.6 years 43 to 42.5 17 years.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies reported the mean age of patients ranging from 31.6 years43 to 42.517 years. Three studies examined patients with an acute pain score ≥3,45 ≥544 or ≥617 out of 10 on an 11-point Numerical Rating Scale (NRS), two studies examined patients with limb trauma,40 43 two studies examined patients with renal colic and NRS ≥639 42 and one study examined patients with long bone fractures and NRS ≥7 41…”

Section: Resultsmentioning

confidence: 99%

“…All included studies were published between 2014 and 2020 (table 1). Five studies were conducted in Iran [39][40][41][42][43] and three were from the USA. 17 44 45 A total of 903 patients were randomised to treatment arms; of which 897 patients were included in formal analyses (69.1% were male; 485 were assigned to intervention and 412 to control).…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

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Subanaesthetic single-dose ketamine as an adjunct to opioid analgesics for acute pain management in the emergency department: a systematic review and meta-analysis

Galili

Nikolajsen

Papadomanolakis-Pakis

2023

BMJ Open

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ObjectiveTo evaluate the effectiveness of a subanaesthetic single-dose ketamine (SDK) as an adjunct to opioids for acute pain in emergency department (ED) settings.DesignSystematic review and meta-analysis.MethodsA systematic search was performed in MEDLINE, Embase, Scopus and Web of Science through March 2022. Randomised controlled trials (RCTs) that investigated SDK as an adjunct to opioids in adult patients for any painful condition in ED settings were selected. Two reviewers screened studies, extracted data and assessed study quality. Data were pooled using random-effects models. The primary outcome was mean pain intensity score measured at baseline, >0–15 min, >15–30 min, >30–45 min, 60 min, 90 min and 120 min. Secondary outcomes included need for rescue analgesia, adverse events and patient satisfaction. Results were reported as mean differences (MDs) and risk ratios. Statistical heterogeneity was calculated using theI2statistic.ResultsEight RCTs were included (n=903). Studies were judged to be at moderate to high risk of bias. Mean pain intensity scores were significantly lower 60 min after study drug administration favouring adjuvant SDK (MD −0.76; 95% CI −1.19 to −0.33), compared with opioids alone. There was no evidence of differences in mean pain intensity scores at any other time point. Patients who received adjuvant SDK were less likely to require rescue analgesia, no more likely to experience serious side effects and had higher satisfaction scores, compared with opioids alone.ConclusionsAvailable evidence suggests adjuvant SDK can have an effect on lowering pain intensity scores. Although reduction of pain scores was not clinically significant, the combination of reduced pain intensity and reduced opioid requirements suggest the results could be clinically important and support the potential utility of SDK as an adjunct to opioids to treat acute pain in adult ED patients. However, current evidence is limited and higher quality RCTs are needed.PROSPERO registration numberCRD42021276708.

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Comparing the analgesic efficacy of morphine plus ketamine versus morphine plus placebo in patients with acute renal colic: A double-blinded randomized controlled trial

Cited by 10 publications

References 17 publications

Comparative Effectiveness of Analgesics to Reduce Acute Pain in the Prehospital Setting

Comparative Effectiveness of Analgesics to Reduce Acute Pain in the Prehospital Setting

Tratamiento farmacológico analgésico del cólico nefrítico

Subanaesthetic single-dose ketamine as an adjunct to opioid analgesics for acute pain management in the emergency department: a systematic review and meta-analysis

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