Comparing Intradermal Sterile Water with Intravenous Morphine in Reducing Pain in Patients with Renal Colic: A Double-Blind Randomized Clinical Trial

Author(s): Javad Mozafari, Mohammadreza Maleki Verki*, Fatemeh Tirandaz, Reza Mahjouri.

Journal Name: Reviews on Recent Clinical Trials

Volume 15 , Issue 1 , 2020

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Graphical Abstract:


Objective: The present study was conducted to investigate the effect of intradermal administration of sterile water compared to intravenous morphine on patients with renal colic.

Methods: This double-blind, randomized clinical trial study was conducted in 2017 to compare the therapeutic effects of intradermal sterile water with those of intravenous morphine on patients with renal colic presenting to the emergency departments (ED) of Imam Khomeini and Golestan Hospitals in Ahvaz, Iran. The first group received 0.5 ml of intradermal sterile water, and the second group 0.1mg/kg of intravenous morphine plus 0.5 ml of intradermal sterile water in the most painful area or the center of the painful area in the flank. The pain severity was measured using a visual analogue scale (VAS), and the medication side-effects were recorded at the beginning of the study and minutes 15, 30,45 and 60.

Results: A total of 94 patients were studied in two groups. The mean severity of pain was 2.97 ± 1.51 in the sterile water group and 2.34 ± 1.89 in the morphine group at minute 30 (P=0.042), 2.58 ± 1.43 in the sterile water group and 1 ± 1.23 in the morphine group at minute 45 (P<0.001), and 1.89 ± 1.7 in the sterile water group and 0.52 ± 0.79 in the morphine group at minute 60 (P<0.001).

Conclusion: Morphine reduces pain faster and more effectively than intradermal sterile water; nevertheless, treatment with intradermal sterile water can be used as an appropriate surrogate or adjunct therapy for pain control, particularly in special patients or in case of medication scarcity.

Keywords: Morphine, pain, renal colic, sterile water, therapeutic effects, clinical trial study.

Mozafari J, Maleki Verki M, Motamed H, Sabouhi A, Tirandaz F. Comparing intranasal ketamine with intravenous fentanyl in reducing pain in patients with renal colic: A double-blind randomized clinical trial. Am J Emerg Med 2019; S0735-6757(19): 30360-2.
[] [PMID: 31155169]
Ramos-Fernández M, Serrano LA. Evaluation and management of renal colic in the emergency department. Bol Asoc Med P R 2009; 101(3): 29-32.
[PMID: 20120983]
Cupisti A, Pasquali E, Lusso S, Carlino F, Orsitto E, Melandri R. Renal colic in Pisa emergency department: Epidemiology, diagnostics and treatment patterns. Intern Emerg Med 2008; 3(3): 241-4.
[] [PMID: 18437291]
Marx J, Walls R, Hockberger R. Rosen's Emergency Medicine Concepts and Clinical Practice E-Book: Elsevier Health Sciences. 2013.
Masoumi K, Forouzan A, Asgari Darian A, Feli M, Barzegari H, Khavanin A. Comparison of clinical efficacy of intravenous acetaminophen with intravenous morphine in acute renal colic: A randomized, double-blind, controlled trial. Emerg Med Int 2014; 2014: 5713-26.
[] [PMID: 25197573]
Pathan SA, Mitra B, Straney LD, et al. Delivering safe and effective analgesia for management of renal colic in the emergency department: A double-blind, multigroup, randomised controlled trial. Lancet 2016; 387(10032): 1999-2007.
[] [PMID: 26993881]
Bihl G, Meyers A. Recurrent renal stone disease-advances in pathogenesis and clinical management. Lancet 2001; 358(9282): 651-6.
[] [PMID: 11530173]
Afshar K, Jafari S, Marks AJ, Eftekhari A, MacNeily AE. Nonsteroidal anti-inflammatory drugs (NSAIDs) and non-opioids for acute renal colic. Cochrane Database Syst Rev 2015; (6): CD006027
[] [PMID: 26120804]
Mårtensson L, Wallin G. Sterile water injections as treatment for low-back pain during labour: A review. Aust N Z J Obstet Gynaecol 2008; 48(4): 369-74.
[] [PMID: 18837842]
Saxena KN, Nischal H, Batra S. Intracutaneous injections of sterile water over the secrum for labour analgesia. Indian J Anaesth 2009; 53(2): 169-73.
[PMID: 20640118]
Fogarty V. Intradermal sterile water injections for the relief of low back pain in labour -- a systematic review of the literature. Women Birth 2008; 21(4): 157-63.
[] [PMID: 18926789]
Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med 2010; 8(1): 18.
[] [PMID: 20334633]
Ahmadnia H, Younesi Rostami M. Treatment of renal colic using intracutaneous injection of sterile water. Urol J 2004; 1(3): 200-3.
[PMID: 17914689]
Bengtsson J, Worning AM, Gertz J, et al. Pain due to urolithiasis treated by intracutaneous injection of sterile water. A clinically controlled double-blind study. Ugeskr Laeger 1981; 143(51): 3463-5.
[PMID: 7039061]
Hosseininejad SM, Emami Zeydi A. Can intracutaneous sterile water injection be used as a possible treatment for acute renal colic pain in the emergency department? A short literature review. Urol Ann 2015; 7(1): 130-2.
[] [PMID: 25657569]
Xue P, Tu C, Wang K, Wang X, Fang Y. Intracutaneous sterile water injection versus oral paracetamol for renal colic during pregnancy: A randomized controlled trial. Int Urol Nephrol 2013; 45(2): 321-5.
[] [PMID: 23443875]
Farag A, Mohammed KS, Morsy MM. Intracutaneous sterile water injections for relief of back pain during labor. Med J Cairo Univ 2015; 83(1): 401-8.
Derry S, Straube S, Moore RA, Hancock H, Collins SL. Intracutaneous or subcutaneous sterile water injection compared with blinded controls for pain management in labour. Cochrane Database Syst Rev 2012; 1: CD009107.
[] [PMID: 22258999]
Pashib M, Tarjoman PR, Mostafavi FS, Abbasi O. Pain intensity, labor duration and satisfaction of labor between anesthesia with fentanyl injection and anesthesia with water injection in women undergoing vaginal delivery. J Torbat Heydariyeh Univ Med Sci 2016; 4(3): 31-7.
Hosseini L, Najar S, Haghighizadeh M. Effect of subcutaneous injection of sterile water on labor pain, type of labor, and satisfaction with pain management in nulliparous women. Hayat (Tihran) 2010; 16(1): 1.
Vakilian K. The effect of sterile water injection in low back labor pain 2004.
Mårtensson L, Wallin G. Labour pain treated with cutaneous injections of sterile water: A randomised controlled trial. Br J Obstet Gynaecol 1999; 106(7): 633-7.
[] [PMID: 10428516]
Trolle B, Møller M, Kronborg H, Thomsen S. The effect of sterile water blocks on low back labor pain. Am J Obstet Gynecol 1991; 164(5 Pt 1): 1277-81.
[] [PMID: 2035569]
Maleki Verki M, Porozan S, Motamed H, Fahimi MA, Aryan A. Comparison the analgesic effect of magnesium sulphate and Ketorolac in the treatment of renal colic patients: Double-blind clinical trial study. Am J Emerg Med 2019; 37(6): 1033-6.
[PMID: 30172601]

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Article Details

Year: 2020
Page: [76 - 82]
Pages: 7
DOI: 10.2174/1574887114666191118153600
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