Introduction: The main purpose of emergency department (ED) management for renal colic is prompt pain relief. The present study aimed to compare the analgesic effects of intravenus (IV) ketofol with morphine in management of ketorolac persistent renal colic. Methods: This study is a single blind randomized, clinical trial, on patients who were presented to ED with renal colic, whose pain was resistant to 30 mg IV ketorolac. The patients were randomly assigned to either IV morphine (0.1 mg/kg) or IV ketofol (0.75 mg/kg propofol and 0.75 mg/kg) and the measures of treatment efficacy were compared between the groups after 5 and 10 minutes. Results: 90 patients with mean age of 38.01 ± 9.78 years were randomly divided into 2 groups of 45 (66.7% male). Treatment failure rate was significantly lower in ketofol group after 5 (20% vs 62.2%, p < 0.001) and 10 minutes (11.1% vs 44.4%, p < 0.001). ARR and NNT for ketofol after 5 miutes were 42.22% (95% CI: 23.86 – 60.59) and 3 (95% CI: 1.7 - 4.2), respectively. After 10 minutes, these measures reached 33.33 (95% CI:16.16 – 50.51) and 4 (95% CI: 2.0 - 6.2), respectively. NNH and ARI for hallucination or agitation were 12 (95%CI: 5.8 - 174.2) and 8.89% (0.57 - 17.20), respectively. Conclusion: The results of the present study, showed the significant superiority of ketofol (NNT at 5 minute = 3 and NNT at 10 minute = 4) in ketorolac resistant renal colic pain management. However, its NNH of 12, could limit its routine application in ED for this purpose.
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.
Green BR. Renal Calculi: Emergency Department Diagnosis And Treatment. Emergency Medicine Practice. 2011:2.
HIATT RA, DALES LG, FRIEDMAN GD, HUNKELER EM. Frequency of urolithiasis in a prepaid medical care program. American journal of epidemiology. 1982;115(2):255-65.
Soucie JM, Thun MJ, Coates RJ, McClellan W, Austin H. Demographic and geographic variability of kidney stones in the United States. Kidney international. 1994;46(3):893-9.
Tramŕr DM, Williams J, Carroll D, Wiffen P, Moore R, McQuay H. Comparing analgesic efficacy of non‐steroidal anti‐inflammatory drugs given by different routes in acute and chronic pain: a qualitative systematic review. Acta Anaesthesiologica Scandinavica. 1998;42(1):71-9.
Ricardo Buenaventura M, Rajive Adlaka M, Nalini Sehgal M. Opioid complications and side effects. Pain physician. 2008;11:S105-S20.
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. Annals of emergency medicine. 2006;48(2):173-81. e1.
Willman EV, Andolfatto G. A prospective evaluation of “ketofol”(ketamine/propofol combination) for procedural sedation and analgesia in the emergency department. Annals of emergency medicine. 2007;49(1):23-30.
White PF, Way WL, Trevor AJ. Ketamine--its pharmacology and therapeutic uses. Anesthesiology. 1982(56):119-36.
Green SM, Rothrock SG, Lynch EL, Ho M, Harris T, Hestdalen R, et al. Intramuscular ketamine for pediatric sedation in the emergency department: safety profile in 1,022 cases. Annals of emergency medicine. 1998;31(6):688-97.
Katalinic N, Lai R, Somogyi A, Mitchell PB, Glue P, Loo CK. Ketamine as a new treatment for depression: A review of its efficacy and adverse effects. Australian and New Zealand Journal of Psychiatry. 2013;47(8):710-27.
Shafer A, Doze V, Shafer S, White P. Pharmacokinetics and pharmacodynamics of propofol infusions during general anesthesia. Anesthesiology. 1988;69(3):348-56.
Nejati A, Moharari RS, Ashraf H, Labaf A, Golshani K. Ketamine/Propofol Versus Midazolam/Fentanyl for Procedural Sedation and Analgesia in the Emergency Department: A Randomized, Prospective, Double‐Blind Trial. Academic Emergency Medicine. 2011;18(8):800-6.
Bird SB, Dickson EW. Clinically significant changes in pain along the visual analog scale. Annals of emergency medicine. 2001;38(6):639-43.
Gallagher EJ, Liebman M, Bijur PE. Prospective validation of clinically important changes in pain severity measured on a visual analog scale. Annals of emergency medicine. 2001;38(6):633-8.
Todd KH. Clinical versus statistical significance in the assessment of pain relief. Annals of emergency medicine. 1996;27(4):439-41.
Cordell WH, Wright SW, Wolfson AB, Timerding BL, Maneatis TJ, Lewis RH, et al. Comparison of intravenous ketorolac, meperidine, and both (balanced analgesia) for renal colic. Annals of emergency medicine. 1996;28(2):151-8.
Larkin GL, Peacock WF, Pearl SM, Blair GA, D'Amico F. Efficacy of ketorolac tromethamine versus meperidine in the ED treatment of acute renal colic. The American journal of emergency medicine. 1999;17(1):6-10.
Oosterlinck W, Philp N, Charig C, Gillies G, Hetherington J, Lloyd J. A Double‐Blind Single Dose Comparison of Intramuscular Ketorolac Tromethamine and Pethidine in the Treatment of Renal Colic. The Journal of Clinical Pharmacology. 1990;30(4):336-41.
Persson NH, Bergqvist D, Melander A, Zederfelt B. Comparison of a narcotic (oxicone) and a non-narcotic anti-inflammatory analgesic (indoprofen) in the treatment of renal colic. Acta chirurgica Scandinavica. 1985;151(2):105-8.
Sandhu D, Iacovou J, Fletcher M, Kaisary A, Philip N, Arkell D. A comparison of intramuscular ketorolac and pethidine in the alleviation of renal colic. British journal of urology. 1994;74(6):690-3.
Smith LA, Carroll D, Edwards JE, Moore RA, McQuay HJ. Single-dose ketorolac and pethidine in acute postoperative pain: systematic review with meta-analysis. British journal of anaesthesia. 2000;84(1):48-58.
Holdgate A, Oh CM. Is there a role for antimuscarinics in renal colic? A randomized controlled trial. The Journal of urology. 2005;174(2):572-5; discussion 5.
Masoumi K, Forouzan A, Asgari Darian A, Feli M, Barzegari H, Khavanin A. Comparison of clinical efficacy of intravenous acetaminophen with intravenous morphine in acute renal colic: a randomized, double-blind, controlled trial. Emergency medicine international. 2014;2014:571326.
Azizkhani R, Pourafzali SM, Baloochestani E, Masoumi B. Comparing the analgesic effect of intravenous acetaminophen and morphine on patients with renal colic pain referring to the emergency department: A randomized controlled trial. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences. 2013;18(9):772-6.
Mortelmans LJ, Desruelles D, Baert JA, Hente KR, Tailly GG. Use of tramadol drip in controlling renal colic pain. Journal of endourology. 2006;20(12):1010-5.
Hassanian-Moghaddam H, Farajidana H, Sarjami S, Owliaey H. Tramadol-induced apnea. The American journal of emergency medicine. 2013;31(1):26-31.
Arora S. Combining ketamine and propofol (“ketofol”) for emergency department procedural sedation and analgesia: a review. Western Journal of Emergency Medicine. 2008;9(1):20.