Intravenous Morphine Plus Ketorolac Is Superior to Either Drug Alone for Treatment of Acute Renal Colic

Study objective

To study the efficacy of intravenous ketorolac, morphine, and both drugs in combination in reducing pain in acute renal colic.

Methods

We conducted a prospective, double-blinded, randomized controlled trial in an urban, teaching emergency department. Patients aged 18 to 55 years and with a clinical diagnosis of acute renal colic and a pain rating greater than 5 on a 10-cm visual analogue scale or at least “moderate pain” on a 4-category verbal pain scale were eligible for inclusion. Exclusion criteria were contraindication to nonsteroidal anti-inflammatory drugs or opiates, a history of drug dependence, presence of peritonitis, or analgesics within 6 hours of presentation. Patients received either morphine 5 mg at time zero and 5 mg at 20 minutes, ketorolac 15 mg at time zero and 15 mg at 20 minutes, or a combination of both. Primary outcomes were pain reduction and the need for rescue analgesia at 40 minutes.

Results

Of the 555 consecutive patients screened, 158 patients met inclusion criteria and 130 patients were randomized during 6 months. Mean difference in change in pain score (visual analog scale 40 minutes minus visual analog scale 0 minutes) between combination group and morphine group was 1.8 cm (95% confidence interval [CI] –3.3 to –0.1) and, compared to the ketorolac group, was 2.2 cm (95% CI –3.7 to –0.5); P<.003. Patients with combination therapy were less likely to require rescue morphine compared to the morphine group (odds ratio 0.2; 95% CI 0.1 to 0.7; P=.007).

Conclusion

A combination of morphine and ketorolac offered pain relief superior to either drug alone and was associated with a decreased requirement for rescue analgesia.