Just when you think you've heard it all – something new and different. This is a randomized, blinded trial of morphine vs intravenous lidocaine for the management of flank pain associated with ureterolithiasis. Why, do you ask? Because, in Iran, they don't have ketorolac as an option for renal colic.
Patients were enrolled based on clinical symptoms, and ureterolithiasis was confirmed by plain radiographs. 240 patients in generally well-balanced groups were enrolled; all patients received 0.15mg/kg IV metoclopramide for nausea, and then the groups were randomized to 0.1mg/kg of morphine vs. 1.5 mg/kg of intravenous lidocaine. Pain outcomes were measured by visual analog scale at 5, 10, 15, and 30 minutes – and the short answer is, they both worked, and neither treatment had terribly significant side effects.
I am all for expanding the toolbox for Emergency Medicine, however unusual the idea might be. After all, every so often, you might need an alternative agent for that extra-special patient who is allergic to ketorolac, morphine, acetaminophen, ondansetron, fentanyl, and the color blue....
"Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department"