1. Randomized Trial of Intravenous Lidocaine Versus Hydromorphone for Acute Abdominal Pain in the Emergency Department.
- Author
-
Chinn E, Friedman BW, Naeem F, Irizarry E, Afrifa F, Zias E, Jones MP, Pearlman S, Chertoff A, Wollowitz A, and Gallagher EJ
- Subjects
- Abdominal Pain diagnosis, Abdominal Pain etiology, Administration, Intravenous, Adult, Analgesics, Opioid administration & dosage, Analgesics, Opioid therapeutic use, Anesthetics, Local administration & dosage, Anesthetics, Local therapeutic use, Emergency Service, Hospital, Female, Humans, Hydromorphone administration & dosage, Lidocaine administration & dosage, Lidocaine therapeutic use, Male, Middle Aged, Nephrolithiasis diagnosis, New York epidemiology, Pain Measurement methods, Treatment Outcome, Abdominal Pain drug therapy, Acute Pain drug therapy, Hydromorphone therapeutic use
- Abstract
Study Objective: 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)., Methods: 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., Results: 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)., Conclusion: 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., (Copyright © 2019 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF