Pain relief in the sickle-cell crisis : intravenous morphine versus ketorolac : a double-blind, randomized clinical trial

• Published in: Iranian red crescent medical journal Vol. 21; no. 4; pp. 1 - 5
• Main Authors: Fateminayyeri, Mahsa, Mir, Hamid Heidarian, Husayni, Somayyehalsadat, Madanitorbati, Faridah, Doluee, Murtada Talibi, Kakhki, Behrang Rezvani
• Format: Journal Article
• Language: English
• Published: Dubai, United Arab Emirates Iranian Hospital 01.04.2019; Zamen Salamati Publishing
• Subjects: Addictions; Analgesics; Clinical trials; Double-blind studies; Morphine; Narcotics; Nonsteroidal anti-inflammatory drugs; Pain management; Patients; Pediatrics; Sickle cell anemia; Sickle cell disease; Standard deviation; Substance abuse treatment; الخلايا المنجلية; المورفين; علم المداواة; مسكنات الألم; القرن الحادي و العشرون
• ISSN: 2074-1804; 2074-1812
• DOI: 10.5812/ircmj.83614

Background: Sickle cell disease (SCD) is a congenital hemoglobinopathy. A low Hb level and high hemoglobin-to-hematocrit ratio may lead to the vaso-occlusive crisis in patients, for the management of which hyperbaric oxygen, hydration, and pain relief therapy are proposed. Objectives: In this study, we sought to compare the effects of morphine and ketorolac on relieving painful sickle cell crisis. Methods: In this double-blind, randomized clinical trial, we recruited 92 SCD patients who referred to the Emergency Department of a university-affiliated hospital, in Mashhad, Iran, from December 2016 to May 2017. The patients were randomly assigned to two groups of ketorolac and morphine injections for relieving pain crisis according to the clinical conditions of the patients. Pain severity was measured by the visual analogue scale before and after the intervention. Data were analyzed using SPSS software. Results: A total of 92 SCD patients were evaluated, while, 19 (21%) were female and 73 (79%) were male, with the mean age of 20.77 ± 8.6 years. At the pre-injection phase, the mean pain scores were 9.1±0.4 and 9.1±0.7 in the ketorolac and morphine groups, respectively. After the intervention, the mean pain scores were 3.7 ± 1.2 and 4.9 ± 2.1 in the ketorolac and morphine groups, respectively. A significant association was found between the pain score after drug injection and the administered drug (P = 0.006). Conclusions: The management of pain crisis with ketorolac injection yielded the same results as the morphine injection in SCD patients. However, ketorolac was found to be associated with fewer side effects than morphine; thus, it can be beneficial for managing SCD patients suffering pain crisis.