Pain Relief in the Sickle-Cell Crisis: Intravenous Morphine Versus Ketorolac; A Double-Blind, Randomized Clinical Trial

Abstract

Background: Sickle cell disease (SCD) is a congenital hemoglobinopathy. A low Hb level and high hemoglobin-to-hematocrit ratio may lead to the vaso-occlusive crisis in patients, for the management of which hyperbaric oxygen, hydration, and pain relief therapy are proposed. Objectives: In this study, we sought to compare the effects of morphine and ketorolac on relieving painful sickle cell crisis. Methods: In this double-blind, randomized clinical trial, we recruited 92 SCD patients who referred to the Emergency Department of a university-affiliated hospital, in Mashhad, Iran, from December 2016 to May 2017. The patients were randomly assigned to two groups of ketorolac and morphine injections for relieving pain crisis according to the clinical conditions of the patients. Pain severity was measured by the visual analogue scale before and after the intervention. Data were analyzed using SPSS software. Results: A total of 92 SCD patients were evaluated, while, 19 (21%) were female and 73 (79%) were male, with the mean age of 20.77 ± 8.6 years. At the pre-injection phase, the mean pain scores were 9.1 ± 0.4 and 9.1 ± 0.7 in the ketorolac and morphine groups, respectively. After the intervention, the mean pain scores were 3.7 ± 1.2 and 4.9 ± 2.1 in the ketorolac and morphine groups, respectively. A significant association was found between the pain score after drug injection and the administered drug (P = 0.006). Conclusions: The management of pain crisis with ketorolac injection yielded the same results as the morphine injection in SCD patients. However, ketorolac was found to be associated with fewer side effects than morphine; thus, it can be beneficial for managing SCD patients suffering pain crisis.

Effectiveness of Topical Ketorolac in Post-hemorrhoidectomy Pain Management: A Clinical Trial

“…The results of another study demonstrated the better analgesic effects of intravenous ketorolac than nebulized fentanyl in patients with renal colic pain ( 22 ). The evidence indicated that injectable ketorolac and morphine produced almost the same analgesic effects in patients with sickle cell disease; nevertheless, ketorolac caused fewer complications ( 23 ). However, Tirupathi et al conducted a review study and concluded that further clinical trials were needed to prove the effectiveness of ketorolac in pain control ( 24 ).…”

A Need for Daycare Unit for Sickle Cell Disease Patients in Oman

“…21 Non-steroidal anti-inflammatory drugs are safer than opioids, with fewer side effects and the same pain-controlling effects. 22 In a qualitative study, many participants expressed their displeasure at being exposed to intravenous opioids at a young age, leading to increased hospitalisations in adulthood and dependence on opioids. 23 Therefore, raising patients' awareness of alternative methods and opioids' adverse effects should not be neglected as this could contribute to limiting frequent use of morphine.…”