Butylscopolammonium bromide does not provide additional analgesia when combined with morphine and ketorolac for acute renal colic
Emergency Medicine Australasia, 04/09/2012
Song SW et al. – Although the addition of butylscopolammonium bromide (BB) to morphine and ketorolac appeared to show a statistically significant reduction in pain compared with morphine and ketorolac alone, a reduction of 1.2cm on visual analogue scale (VAS) is unlikely to be clinically significant.
A prospective, double-blind, randomized controlled trial of i.v. triple therapy (morphine, ketorolac and BB) versus double therapy (morphine and ketorolac) in adult ED patients with a clinical diagnosis of acute renal colic and a pain rating greater than five on a 10cm visual analogue scale (VAS).
VAS was recorded at time 0, 20 and 40min.
Patients received rescue morphine at 20 or 40min according to the protocol if needed.
The authors compared pain reduction and the need for rescue analgesia at 4min between two groups.
Eighty-nine patients were randomized over a 13month period.
A total of 46 (51.7%) patients received BB in addition to morphine and ketorolac.
The mean difference in change in pain score in the triple therapy group and double therapy group was 7.1cm (95% CI 6.4-7.8) and 5.9cm (95% CI 5.1-6.7), respectively (P=0.024).
Rescue morphine was required by 7/46 (15.2% [95% CI 4.4-20.6]) patients in the triple therapy group and 14/43 (32.6% [95% CI 18.0-47.1]) in the double therapy group (OR 0.37 [95% CI 0.133-1.038]).
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