The analgesic effect of sublingual buprenorphine was comparable to that of intravenous morphine.
Emergency clinicians commonly administer intravenous opioids to relieve pain in renal colic patients. But would a sublingual analgesic be as effective? To find out, investigators in Iran conducted a double-blind, double-dummy, placebo-controlled, randomized trial of sublingual buprenorphine (2 mg), versus intravenous morphine (0.1 mg/kg) in 69 patients with acute renal colic.
Pain relief at 20 and 40 minutes after treatment and the need for rescue analgesia were similar with buprenorphine or morphine; dizziness was more common with buprenorphine (62% vs. 38%).
Reviewing Author
DisclosuresConsultant/Advisory BoardPortola Pharmaceuticals, Inc.
Speaker’s BureauPeerView Institute for Medical Education
Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals
DisclosuresConsultant/Advisory BoardPortola Pharmaceuticals, Inc.
Speaker’s BureauPeerView Institute for Medical Education
Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals
Citation(s):
Payandemehr P et al. Sublingual buprenorphine for acute renal colic pain management: A double-blind, randomized controlled trial. Int J Emerg Med 2014 Jan 3; 7:1. (http://dx.doi.org/10.1186/1865-1380-7-1)
Comment
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstay of treatment of renal colic, but opioids are useful for rapid pain relief in the initial phase and for breakthrough pain with NSAID use. Intravenous opioids are often used because of their rapid effect and ease of titration. This study demonstrates that opioids may be given sublingually. Because there is no proven value to administration of intravenous fluids, such an approach facilitates prompt, effective treatment of renal colic without the need for an intravenous line.