Randomized Trial of Intravenous Lidocaine Versus Hydromorphone for Acute Abdominal Pain in the Emergency Department.
Abdominal Pain
/ diagnosis
Acute Pain
/ drug therapy
Administration, Intravenous
Adult
Analgesics, Opioid
/ administration & dosage
Anesthetics, Local
/ administration & dosage
Emergency Service, Hospital
Female
Humans
Hydromorphone
/ administration & dosage
Lidocaine
/ administration & dosage
Male
Middle Aged
Nephrolithiasis
/ diagnosis
New York
/ epidemiology
Pain Measurement
/ methods
Treatment Outcome
Journal
Annals of emergency medicine
ISSN: 1097-6760
Titre abrégé: Ann Emerg Med
Pays: United States
ID NLM: 8002646
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
received:
31
10
2018
revised:
11
12
2018
accepted:
07
01
2019
pubmed:
2
3
2019
medline:
13
3
2020
entrez:
2
3
2019
Statut:
ppublish
Résumé
We compare the efficacy and safety of intravenous lidocaine with that of hydromorphone for the treatment of acute abdominal pain in the emergency department (ED). This was a randomized, double-blind, clinical trial conducted in 2 EDs in the Bronx, NY. Adults weighing 60 to 120 kg were randomized to receive 120 mg of intravenous lidocaine or 1 mg of intravenous hydromorphone. Thirty minutes after administration of the first dose of the study drug, participants were asked whether they needed a second dose of the investigational medication to which they were randomized. Patients were also stratified according to clinical suspicion of nephrolithiasis. The primary outcome was improvement in pain scores of 0 to 10 between baseline and 90 minutes. An important secondary outcome was need for "off-protocol" parenteral analgesics, including opioids and nonsteroidal anti-inflammatory drugs. We enrolled 154 patients, of whom 77 received lidocaine and 77 received hydromorphone. By 90 minutes, patients randomized to lidocaine improved by a mean of 3.8 points on the 0-to-10 scale, whereas those randomized to hydromorphone improved by a mean of 5.0 points (mean difference 1.2; 95% confidence interval 0.3 to 2.2). Need for off-protocol "rescue" analgesics occurred for 39 of 77 lidocaine patients (51%) and 20 of 77 hydromorphone patients (26%) (difference 25%; 95% confidence interval 10% to 40%). Adverse events were comparable between groups. Among the subset of 22 patients with nephrolithiasis, lidocaine patients reported a mean improvement of 3.4 points on the pain scale, whereas hydromorphone patients reported a mean improvement of 6.4 points (mean difference 3.0; 95% confidence interval 0.5 to 5.5). Intravenous hydromorphone was superior to intravenous lidocaine both for general abdominal pain and a subset of patients with nephrolithiasis. A majority of patients randomly allocated to lidocaine required additional analgesics.
Identifiants
pubmed: 30819520
pii: S0196-0644(19)30043-5
doi: 10.1016/j.annemergmed.2019.01.021
pmc: PMC6764530
mid: NIHMS1519000
pii:
doi:
Substances chimiques
Analgesics, Opioid
0
Anesthetics, Local
0
Lidocaine
98PI200987
Hydromorphone
Q812464R06
Banques de données
ClinicalTrials.gov
['NCT03300674']
Types de publication
Comparative Study
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
233-240Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR001073
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002556
Pays : United States
Informations de copyright
Copyright © 2019 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
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