Comparison of rectal suppository and intramuscular morphine for management of patients with renal colic referred to the emergency department: A randomized double-blinded controlled trial
DOI:
https://doi.org/10.22317/jcms.v9i1.1316Keywords:
Renal Colic, Morphine, Pain Management, Suppositories, Injections, IntramuscularAbstract
Objectives: To compare the analgesic effects of rectal suppository morphine (RSM) with intramuscular morphine (IMM) in patients suffered from renal colic referred to emergency ward (EW).
Methods: In a controlled, randomized, clinical trial, 74/90 patients with renal colic referred to the EW between March 2016 and March 2017 were randomly enrolled into two groups of RSM (10 mg) and IMM (10 mg/mL). Vital signs and severity of pain were recorded at admission time (0), 15, 30 and 60 min after treatment.
Results: The results showed that there was a significant decrease in VAS score of RSM group compared to IMM group after 30 and 60 min of administration (P˂0.05). Furthermore, no significant difference was recorded in vital signs, except there was a significant decrease in heart rate (15 and 60 min) and respiratory rate (60 min) of RSM group compared to IMM group (P˂0.05) and no side effects were recorded during the investigation.
Conclusion: In conclusion, the use of rectal route of morphine had higher efficiency compared to the IM route of morphine in relieving pain of patients with renal colic. Although, decreased heart and respiratory rates were recorded, the values were in normal range. As well, no major complications were recorded for each method.
References
Golzari SE, Soleimanpour H, Rahmani F, Zamani Mehr N, Safari S, Heshmat Y, et al. Therapeutic approaches for renal colic in the emergency department: a review article. Anesth Pain Med. 2014;4(1):e16222.
Basiri A, Shakhssalim N, Khoshdel AR, Pakmanesh H, Radfar MH. Drinking water composition and incidence of urinary calculus: introducing a new index. Iranian journal of kidney diseases. 2011;5(1):15.
Phillips E, Hinck B, Pedro R, Makhlouf A, Kriedberg C, Hendlin K, et al. Celecoxib in the management of acute renal colic: a randomized controlled clinical trial. Urology. 2009;74(5):994-9.
Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Reviews in urology. 2010;12(2-3):e86.
Holdgate A, Pollock T. Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic. Bmj. 2004;328(7453):1401.
Faridaalaee G, Mohammadi N, Merghati SZ. Intravenous morphine vs intravenous ketofol for treating renal colic; a randomized controlled trial. Emergency. 2016;4(4):202.
Edwards JE, Meseguer F, Faura C, Moore RA, McQuay HJ. Single dose dipyrone for acute renal colic pain. The Cochrane database of systematic reviews. 2002(4):Cd003867.
Iguchi M, Katoh Y, Koike H, Hayashi T, Nakamura M. Randomized trial of trigger point injection for renal colic. International journal of urology : official journal of the Japanese Urological Association. 2002;9(9):475-9.
Serinken M, Karcioglu O, Turkcuer I, Ozkan HI, Keysan MK, Bukiran A. Analysis of clinical and demographic characteristics of patients presenting with renal colic in the emergency department. BMC research notes. 2008;1:79.
Renal colic in adults: NSAIDs and morphine are effective for pain relief. Prescrire international. 2009;18(103):217-21.
Larkin GL, Peacock WFt, Pearl SM, Blair GA, D'Amico F. Efficacy of ketorolac tromethamine versus meperidine in the ED treatment of acute renal colic. Am J Emerg Med. 1999;17(1):6-10.
Rahimi M, Farsani DM, Naghibi K, Alikiaii B. Preemptive morphine suppository for postoperative pain relief after laparoscopic cholecystectomy. Advanced biomedical research. 2016;5.
de Boer AG, Moolenaar F, de Leede LG, Breimer DD. Rectal drug administration: clinical pharmacokinetic considerations. Clinical pharmacokinetics. 1982;7(4):285-311.
Morgan S. Intravenous paracetamol in patients with renal colic. Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association. 2011;18(9):22-5.
Blankenstein TN, Gibson LM, Claydon MA. Is intramuscular morphine satisfying frontline medical personnels' requirement for battlefield analgesia in Helmand Province, Afghanistan? A questionnaire study. British journal of pain. 2015;9(2):115-21.
Walford J. Comparison of intravenous morphine and paracetamol. Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association. 2015;23(5):24-7.
Poonai N, Datoo N, Ali S, Cashin M, Drendel AL, Zhu R, et al. Oral morphine versus ibuprofen administered at home for postoperative orthopedic pain in children: a randomized controlled trial. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2017;189(40):E1252-e8.
Cole L, Hanning CD. Review of the rectal use of opioids. Journal of pain and symptom management. 1990;5(2):118-26.
Ducharme J. Analgesia, Anesthesia, and Procedural Sedation. Tintinalli’s Emergency Medicine. 2015:231-8.
Safdar B, Degutis LC, Landry K, Vedere SR, Moscovitz HC, D'Onofrio G. Intravenous morphine plus ketorolac is superior to either drug alone for treatment of acute renal colic. Ann Emerg Med. 2006;48(2):173-81, 81.e1.
Turkcuer I, Serinken M, Karcioglu O, Zencir M, Keysan MK. Hospital cost analysis of management of patients with renal colic in the emergency department. Urological research. 2010;38(1):29-33.
Holdgate A, Pollock T. Nonsteroidal anti‐inflammatory drugs (NSAIDS) versus opioids for acute renal colic. Cochrane Database of Systematic Reviews. 2004(1).
Golzari SE, Soleimanpour H, Rahmani F, Mehr NZ, Safari S, Heshmat Y, et al. Therapeutic approaches for renal colic in the emergency department: a review article. Anesthesiology and pain medicine. 2014;4(1).
Portis AJ, Sundaram CP. Diagnosis and initial management of kidney stones. American family physician. 2001;63(7):1329-38.
Nakhaei Amroodi M, Reza Shafiee G, Mokhtari T. Prevalence of the Shoulder Dislocation Due to Tramadol-Induced Seizure. Shafa Ortho J. 2015;2(1).
Beltaief K, Grissa MH, Msolli MA, Bzeouich N, Fredj N, Sakma A, et al. Acupuncture versus titrated morphine in acute renal colic: a randomized controlled trial. Journal of pain research. 2018;11:335.
Mangal R, Higgins D, Pham T. Is intravenous (IV) acetaminophen as effective as IV morphine for treatment of renal colic? Evidence-Based Practice. 2018;21(3):6.
Etteri M, Maj M, Maino C, Valli R. Intranasal ketorolac and opioid in treatment of acute renal colic. Emergency Care Journal. 2018;14(1).
Tveita T, Thoner J, Klepstad P, Dale O, Jystad A, Borchgrevink PC. A controlled comparison between single doses of intravenous and intramuscular morphine with respect to analgesic effects and patient safety. Acta Anaesthesiol Scand. 2008;52(7):920-5.
Borracci T, Cappellini I, Campiglia L, Picciafuochi F, Berti J, Consales G, et al. Preoperative medication with oral morphine sulphate and postoperative pain. Minerva anestesiologica. 2013;79(5):525-33.
Australian and New Zealand College of anaesthetists and faculty of pain medicine: Acute pain management: Scientific evidence. 2005.
Thomas SH. Management of pain in the emergency department. ISRN Emergency Medicine. 2013;2013.
Rogers E, Mehta S, Shengelia R, Reid MC. Four Strategies for Managing Opioid-Induced Side Effects in Older Adults. Clinical geriatrics. 2013;21(4):http://www.consultant360.com/articles/four-strategies-managing-opioid-induced-side-effects-older-adults.
Butler KA, Yi J, Klauschie J, Ryan DL, Hentz JG, Cornella JL, et al. 7: Randomized clinical trial of postoperative belladonna and opium (B&O) suppositories in vaginal surgery. American Journal of Obstetrics & Gynecology. 2016;214(4):S459.
Hanning CD, Vickers AP, Smith G, Graham NB, McNeil ME. THE MORPHINE HYDROGEL SUPPOSITORY: A New Sustained Release Rectal Preparation. British Journal of Anaesthesia. 1988;61(2):221-7.
Butler K, Yi J, Wasson M, Klauschie J, Ryan D, Hentz J, et al. Randomized controlled trial of postoperative belladonna and opium rectal suppositories in vaginal surgery. American Journal of Obstetrics and Gynecology. 2017;216(5):491.e1-.e6.
Butler K, Yi J, Wasson M, Klauschie J, Ryan D, Hentz J, et al. Randomized controlled trial of postoperative belladonna and opium rectal suppositories in vaginal surgery. American Journal of Obstetrics & Gynecology. 2017;216(5):491.e1-.e6.
Cole L, Hanning CD, Robertson S, Quinn K. Further development of a morphine hydrogel suppository. British journal of clinical pharmacology. 1990;30(6):781-6.
Guldbrand P, Mellstrom A. Rectal versus intramuscular morphine-scopolamine as premedication in children. Acta anaesthesiologica Scandinavica. 1995;39(2):224-7.
Wilkinson TJ, Robinson BA, Begg EJ, Duffull SB, Ravenscroft PJ, Schneider JJ. Pharmacokinetics and efficacy of rectal versus oral sustained-release morphine in cancer patients. Cancer chemotherapy and pharmacology. 1992;31(3):251-4.
Stanski DR, Greenblatt DJ, Lowenstein E. Kinetics of intravenous and intramuscular morphine. Clinical pharmacology and therapeutics. 1978;24(1):52-9.
Jonsson T, Christensen CB, Jordening H, Frølund C. The bioavailability of rectally administered morphine. Pharmacology & toxicology. 1988;62(4):203-5.
Westerling D, Lindahl S, Andersson KE, Andersson A. Absorption and bioavailability of rectally administered morphine in women. European journal of clinical pharmacology. 1982;23(1):59-64.
Babul N, Provencher L, Laberge F, Harsanyi Z, Moulin D. Comparative efficacy and safety of controlled‐release morphine suppositories and tablets in cancer pain. The Journal of Clinical Pharmacology. 1998;38(1):74-81.
Barnhart MD, Hubbell JA, Muir WW, Sams RA, Bednarski RM. Pharmacokinetics, pharmacodynamics, and analgesic effects of morphine after rectal, intramuscular, and intravenous administration in dogs. American journal of veterinary research. 2000;61(1):24-8.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Journal of Contemporary Medical Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.