Butylscopolammonium bromide does not provide additional analgesia when combined with morphine and ketorolac for acute renal colic
Emergency Medicine Australasia,  Clinical Article

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.

Methods
  • 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.

Results
  • 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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