IV morphine plus ketorolac relieved pain more effectively than either drug alone.
A recent meta-analysis of clinical trials suggested that NSAIDs might achieve slightly better pain relief than opioids in patients with renal colic (Journal Watch Jul 20 2004). However, meperidine was the most commonly used opioid in those trials, and combination therapy was not addressed. In this placebo-controlled randomized trial from Yale University, 130 generally healthy patients (age range, 18–55) with acute renal colic were randomized to receive morphine (5 mg intravenously initially and at 20 minutes), ketorolac (Toradol and generics; 15 mg intravenously initially and at 20 minutes), or both drugs.
At baseline, the mean pain score in each group was about 8.8 on a 10-point visual-analog scale. At 40 minutes, the mean score was significantly lower in the combination-therapy group (2.0) than in the morphine group (3.7) or the ketorolac group (4.1). Side effects (mainly nausea) were more common with morphine alone than with ketorolac alone or combination therapy.
Comment: These results suggest that a combination of morphine and ketorolac, both given intravenously, is a reasonable option for relatively young, healthy patients with severe renal colic. One limitation of this study was the short observation period of only 40 minutes; the course of pain during the subsequent few hours would have been of interest.
— Allan S. Brett, MD
Published in Journal Watch September 14, 2006
Citation(s):
Safdar B et al. Intravenous morphine plus ketorolac is superior to either drug alone for treatment of acute renal colic. Ann Emerg Med 2006 Aug; 48:173-81.