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SYSTEMATIC REVIEW: INTRAVENOUS PARACETAMOL VERSUS INTRAVENOUS MORPHINE IN THE MANAGEMENT OF ACUTE RENAL COLIC
  1. R Navaratnam,
  2. S Parker
  1. Emergency Medicine, Pembury Hospital, Tunbridge Wells, UK

    Abstract

    Objectives & Background Renal colic is commonly managed in emergency departments worldwide. Initial treatment requires prompt and effective analgesia. The mainstay of analgesia revolves around non-steroidal analgesics and opiates. Though effective they are associated with a number of significant side effects.

    Paracetamol is available in a number of preparations. The intravenous route has been shown to be effective within 10 minutes of administration and is associated with few adverse side effects.

    The aim of this review is to assess the available evidence comparing the analgesic effect of intravenous paracetamol versus intravenous morphine in renal colic.

    Methods A systematic review of medical databases was undertaken (June 2015). Databases searched included Embase (1946 to May 2015 Week 1), Medline (1946 to June 2015) Google Scholar and the Cochrane Database of Systematic Reviews.

    The terms searched were:

    • 1. (Renal colic OR ureteric colic OR nephrolithasis)

    • 2. (Acetaminophen OR paracetamol) AND morphine

    After the searches were combined, the following limits were imposed: English language, human subjects, aged 18–60, presenting acutely, use of intravenous forms of the drugs, the diagnosis of renal colic radiologically confirmed.

    Results A total of 66 papers were returned after the initial search. 3 further papers were identified following analysis of the references of search results. Abstracts were reviewed for inclusion, resulting in the exclusion of 66 studies.

    A total of 348 patients were analysed over 3 studies. Patient demographics, doses of paracetamol and morphine used and the measure of effect was similar across the studies.

    Mean baseline visual analogue pain scores were similar across studies (Mean: Paracetamol 8.05, Morphine 8.40). All 3 studies showed paracetamol reduced visual analogue pain scores at both 15 minutes (Mean: Paracetamol=4.32 vs Morphine=5.26) and 30 minutes (Mean: Paracetamol=2.55 vs Morphine=3.67) following administration. The need for ‘rescue’ analgesia was reduced in patients receiving paracetamol. The number of adverse events experienced by patients recieving paracetamol was less versus those receiving morphine.

    Conclusion Review of the literature suggests intravenous paracetamol is as effective as intravenous morphine in providing analgesia in acute renal colic. This effect was associated with a reduced incidence of adverse events and need for supplemental analgesia.

    • emergency departments

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