title: Butylscopolammonium bromide does not provide additional analgesia when combined with morphine and ketorolac for acute renal colic.
abstract: OBJECTIVE
  To evaluate the effect of adding butylscopolammonium bromide (BB) to morphine and ketorolac in the treatment of acute renal colic in the ED.
  
  
  METHODS
  A prospective, double-blind, randomized controlled trial of i.v. triple therapy (morphine, ketorolac and BB) versus double therapy (morphine and ketorolac) in adult ED patients with a clinical diagnosis of acute renal colic and a pain rating greater than five on a 10 cm visual analogue scale (VAS). VAS was recorded at time 0, 20 and 40 min. Patients received rescue morphine at 20 or 40 min according to the protocol if needed. We compared pain reduction and the need for rescue analgesia at 4 min between two groups.
  
  
  RESULTS
  Eighty-nine patients were randomized over a 13 month period. A total of 46 (51.7%) patients received BB in addition to morphine and ketorolac. The mean difference in change in pain score in the triple therapy group and double therapy group was 7.1 cm (95% CI 6.4-7.8) and 5.9 cm (95% CI 5.1-6.7), respectively (P= 0.024). Rescue morphine was required by 7/46 (15.2% [95% CI 4.4-20.6]) patients in the triple therapy group and 14/43 (32.6% [95% CI 18.0-47.1]) in the double therapy group (OR 0.37 [95% CI 0.133-1.038]).
  
  
  CONCLUSIONS
  Although the addition of BB to morphine and ketorolac appeared to show a statistically significant reduction in pain compared with morphine and ketorolac alone, a reduction of 1.2 cm on VAS is unlikely to be clinically significant.
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, Sungnam-si, Seoul, Korea.
authors.forename: Sung Wook
authors.initials: SW
authors.lastname: Song
authors.forename: Kyuseok
authors.initials: K
authors.lastname: Kim
authors.forename: Joong Eui
authors.initials: JE
authors.lastname: Rhee
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Lee
authors.forename: Gil Joon
authors.initials: GJ
authors.lastname: Seo
authors.forename: Hyun Mi
authors.initials: HM
authors.lastname: Park
mesh_terms: D000328:Adult; D000698:Analgesia / Q000379:methods; D002086:Butylscopolammonium Bromide / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000627:therapeutic use; D010147:Pain Measurement; D011182:Postoperative Care; D011446:Prospective Studies; D056844:Renal Colic / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D002086:Butylscopolammonium Bromide; D009020:Morphine; D020910:Ketorolac