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Acupuncture versus titrated morphine in acute renal colic: a randomized controlled trial

Objective: The objective of this study was to compare the analgesic effect and tolerance profile of acupuncture versus intravenous (IV) titrated morphine in patients presenting to the emergency department (ED) with renal colic.

Materials and methods: A total of 115 patients were randomized into two groups. Patients in the IV titrated-morphine group (n=61) received 0.1 mg/kg morphine every 5 minutes until pain score dropped by at least 50% of its baseline value. Patients in the acupuncture group (n=54) received an acupuncture session of 30 minutes following a prespecified protocol. The visual analog scale (VAS) was used to assess pain intensity at baseline and at 10, 20, 30, 45, and 60 minutes following the start of the treatment protocol. Possible treatment side effects were also recorded.

Results: No significant differences were found between the two groups concerning age, sex, or baseline VAS score. From the 10th minute until the end of the intervention, acupuncture was associated with a deeper analgesic effect than titrated morphine (P<0.05 from the 10th minute and over). Analgesia was also faster in the acupuncture group, with time to obtain 50% reduction of baseline VAS of 14 minutes in the acupuncture group versus 28 minutes in the IV titrated-morphine group (P<0.001). Only three patients in the acupuncture group experienced minor side effects versus 42 in the morphine group (P<0.001). No major side effects were observed in this study.

Conclusion: In ED patients with renal colic, acupuncture was associated with a much faster and deeper analgesic effect and a better tolerance profile in comparison with titrated IV morphine.

Interventions
Patients were randomly assigned to one of the two study groups using a randomly generated number protocol and sealed envelopes. Patients allocated to the titrated-morphine group received a bolus of 0.1 mg/kg actual body weight of morphine chloral hydrate solution by direct IV route. This solution had been prepared by a study nurse by diluting a 10 mg/1 mL of morphine chloral hydrate in 9 mL solution of serum saline to obtain a 10 mL preparation. A titration dose of 0.1 mg/kg body weight was repeated every 5 minutes until reaching the therapeutic goal. In the acupuncture group, patients underwent a  30-minute acupuncture session with a licensed physician. Skin was disinfected with chlorhexidine at the needle insertion site. Sterile acupuncture needles were used (0.25×0.5 mm). Patients were installed in a seated position and needles inserted perpendicularly through the skin to a depth of 1–2 cm until deqi, a feeling of numbness and tingling within the range of the acupuncture point, was achieved.14 Insertion sites correspond to the urinary bladder meridian points to the side of the pain (UB21–24, UB26, UB45–49) UB=Blase.

Authors: Kaouthar Beltaief1,2 Mohamed Habib Grissa1,2 Mohamed Amine Msolli1,2 Nasri Bzeouich1,2 Nizar Fredj1,2 Adel Sakma1,2 Hamdi Boubaker1,2 Wahid Bouida1,2 Riadh Boukef1,3 Semir Nouira1,2 1Emergency Department, Fattouma Bourguiba University Hospital, 2Research Laboratory LR12SP18, University of Monastir, Monastir, 3Emergency Department, Sahloul University Hospital, Sousse, Tunisia

Quelle: Journal of Pain Research  2018:11 335–341

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