Comparison of the Analgesic Effect of Intravenous Ketamine versus Intravenous Morphine in Reducing Pain of Renal Colic Patients: Double-Blind Clinical Trial Study

Abstract

Background: The effective relief of renal colic patients with low complications is one of the important concerns of emergency physicians. The aim of this study was to investigate the use of injectable ketamine as an alternative to routine drugs in the relief of pain in patients with renal colic. Methods: This double-blind clinical trial was conducted on patients who had suffered kidney pain due to kidney stones in 2017, referred to Ahvaz Imam Khomeini Hospital. Patients were divided into 2 groups: the first group received intravenous ketamine (0.3 mg/kg) and the second group received intravenous morphine (0.1 mg/kg) in a double-blind form. Finally, the mean pain was evaluated before injection, after 10, 20, 30, and 60 minutes as the initial result while the side effects were considered as secondary results. Results: In this study, 135 patients with renal colic participate in this study. The mean pain at the time of referral to the hospital in the group receiving morphine and ketamine was 9.2 and 9.2, respectively, which did not show any significant difference. Based on these findings, there was no significant difference between the factors evaluated during the study of the two groups. Only in the ketamine group, there were 3 cases of nausea and 1 of vomiting. However, there was a significant increase in the need for additional doses of fentanyl in the morphine recipient group (p = 0.02). Conclusion: The findings suggest that the use of ketamine can produce a more rapid relief effect, and decrease the use of opioids which create various complications, including nausea and vomiting in patients, especially patients with renal colic.

Low‐dose Ketamine For Acute Pain Control in the Emergency Department: A Systematic Review and Meta‐analysis

“…Six studies, with a total of 757 patients (380 in the LDK group and 377 in the morphine group) reported a pain score within 15 minutes of analgesic administration (Figure 2). 12–14,20,21,23 The pooled estimate showed no significant difference in mean pain scores between LDK and morphine within 15 minutes (MD = −0.15, 95% CI = −0.68 to 0.38). Six studies reported a pain score between 15 and 30 minutes 13,14,20–23 .…”

“… 12–14,20,21,23 The pooled estimate showed no significant difference in mean pain scores between LDK and morphine within 15 minutes (MD = −0.15, 95% CI = −0.68 to 0.38). Six studies reported a pain score between 15 and 30 minutes 13,14,20–23 . The pooled estimate showed no significant difference in mean pain scores between groups (MD = −0.03, 95% CI = −0.37 to 0.32).…”

“…A summary of the included trials is shown in Table 1. All studies were published between 2014 and 2019 12–14,20–24 . One study was reported as an abstract 24 .…”

“…All studies used morphine boluses of 0.1 mg/kg intravenously. Four studies examined patients with abdominal, flank, low back, or extremity pain; 13,14,20,21 two studies examined patients with long‐bone fractures; 12,22 one study examined trauma patients with musculoskeletal pain; 23 and one study examined those with a sickle cell pain crisis 24 . All studies were conducted in the ED, with no prehospital studies included.…”

“…Although the use of ketamine to manage acute pain is relatively novel within the ED, it has unique features that could lend itself to improved patient outcomes, particularly for the specific populations described. An increasing number of studies have examined ketamine in comparison to opioids for pain control in the ED 12–14 . A previous systematic review and meta‐analysis of three studies compared ketamine to morphine for acute pain control in the ED, but only included patients between the ages of 18 and 65 years and only examined short‐term pain control as a primary outcome 15 .…”