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Arzneimittelforschung 2012; 62(12): 603-608
DOI: 10.1055/s-0032-1327678
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Ketorolac Tromethamine Improves the Analgesic Effect of Hyoscine Butylbromide in Patients with Intense Cramping Pain from Gastrointestinal or Genitourinary Origin

C. F. del Valle-Laisequilla
1   Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional. Mexico, D.F., Mexico
,
F. J. Flores-Murrieta
1   Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional. Mexico, D.F., Mexico
2   Instituto Nacional de Enfermedades Respiratorias, Secretaría de Salud. Mexico, D.F., Mexico
,
V. Granados-Soto
3   Departamento de Farmacobiología, Centro de Investigación y de Estudios Avanzados (Cinvestav), Sede Sur. México, D.F., Mexico
,
H. I. Rocha-González
1   Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional. Mexico, D.F., Mexico
,
G. Reyes-García
1   Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional. Mexico, D.F., Mexico
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Publikationsverlauf

received 27. Juni 2012

accepted 02. Oktober 2012

Publikationsdatum:
23. Oktober 2012 (online)

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Abstract

The symptomatic treatment of pain associated with spasm of gastrointestinal or genitourinary origin can include the use of spasmolytic agents and/or non-steroidal anti-inflammatory drugs. However, the evidence of a superior effectiveness of combination in comparison with individual drugs is scarce and controversial. A double-blind, randomised, clinical trial study was designed to characterize the analgesic effect and safety of ketorolac and hyoscine butylbromide against hyoscine butylbromide alone in patients with ambulatory acute cramping pain of gastrointestinal and genitourinary origin. 160 patients with a pain level ≥4 in a 1–10 cm visual analogue scale were allocated to receive a fixed dose of ketorolac/hyoscine butylbromide (10 mg/20 mg) or hyoscine butylbromide (20 mg) alone at 6 h intervals, during a 48 h period. Both treatments were similarly effective when compared as a whole or when groups were classified by pain origin. Conversely, when treatments were grouped by pain intensity, ketorolac/hyoscine butylbromide combination showed a significant better pain relief profile than hyoscine butylbromide alone in pain intensity ≥7, but not <7. Data indicate that the oral ketorolac/hyoscine butylbromide mixture could be a better option than hyoscine butylbromide alone in the treatment of some acute intense cramping painful conditions.

Key words

visceral pain - ketorolac - hyoscine butylbromide - spasmolytic - NSAID
 

  • References

  • 1 Sandler RS, Stewart WF, Liberman JN et al. Abdominal pain, bloating, and diarrhea in the United States: prevalence and impact. Dig Dis Sci 2000; 45: 1166-1171
    CrossrefPubMedGoogle Scholar
  • 2 Abdo-Francis JM, Martínez-Juárez A, Pineda-Corona B et al. Un nuevo esquema terapéutico en el manejo del dolor abdominal de tipo cólico. Rev Med Hosp Gen Mex 2003; 66: 142-146
    PubMedGoogle Scholar
  • 3 Poynard T, Regimbeau C, Benhamou Y. Meta-analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther 2001; 15: 355-361
    CrossrefPubMedGoogle Scholar
  • 4 Jailwala J, Imperiale TF, Kroenke K. Pharmacologic treatment of the irritable bowel syndrome: a systematic review of randomized, controlled trials. Ann Intern Med 2000; 133: 136-147
    CrossrefPubMedGoogle Scholar
  • 5 Kumar A, Deed JS, Bhasin B et al. Comparison of the effect of diclofenac with hyoscine-N-butylbromide in the symptomatic treatment of acute biliary colic. ANZ J Surg 2004; 74: 573-576
    CrossrefPubMedGoogle Scholar
  • 6 Larkin GL, Peacock 4th WF, Pearl SM et al. Efficacy of ketorolac tromethamine versus meperidine in the ED treatment of acute renal colic. Am J Emerg Med 1999; 17: 6-10
    CrossrefPubMedGoogle Scholar
  • 7 Larsen LS, Miller A, Allegra JR. The use of intravenous ketorolac for the treatment of renal colic in the emergency department. Am J Emerg Med 1993; 11: 197-199
    CrossrefPubMedGoogle Scholar
  • 8 Sarkar S, Hobson AR, Hughes A et al. The prostaglandin E2 receptor-1 (EP-1) mediates acid-induced visceral pain hypersensitivity in humans. Gastroenterology 2003; 124: 18-25
    CrossrefPubMedGoogle Scholar
  • 9 Giamberardino MA, Valente R, De Bigontina P et al. Effects of spasmolytic and/or non-steroidal antiinflammatory drugs on muscle hyperalgesia of ureteral origin in rats. Eur J Pharmacol 1995; 278: 97-101
    CrossrefPubMedGoogle Scholar
  • 10 Cataño JG, Rojas C, Patiño G. N-butilbromuro de hioscina más dipirona, tramadol y diclofenaco en el manejo del cólico renoureteral. Univ Méd Bogotá Colombia 2004; 45: 69-73
    PubMedGoogle Scholar
  • 11 Lloret J, Munoz J, Monmany J et al. Treatment of renal colic with dipyrone. Treatment of renal colic with dipyrone. A double-blind comparison trial with hyoscine alone or combined with dipyrone. Curr Ther Res Clin Exp 1987; 42: 1119-1128
    PubMedGoogle Scholar
  • 12 Mueller-Lissner S, Tytgat GN, Paulo LG et al. Placebo- and paracetamol-controlled study on the efficacy and tolerability of hyoscine butylbromide in the treatment of patients with recurrent crampy abdominal pain. Aliment Pharmacol Ther 2006; 23: 1741-1748
    CrossrefPubMedGoogle Scholar
  • 13 Tytgat GN. Hyoscine butylbromide: a review of its use in the treatment of abdominal cramping and pain. Drugs 2007; 67: 1343-1357
    CrossrefPubMedGoogle Scholar
  • 14 Evangelista S. Quaternary ammonium derivatives as spasmolytics for irritable bowel syndrome. Curr Pharm Des 2004; 10: 3561-3568
    CrossrefPubMedGoogle Scholar
  • 15 Pennefather JN, McCulloch MW, Rand MJ. Observations on the efficacy of oral hyoscine N-butyl bromide. J Pharm Pharmacol 1968; 20: 867-872
    CrossrefPubMedGoogle Scholar
  • 16 Lecchini S, Del Tacca M, Soldani G et al. The actions of atropine, tropenziline and N-butyl hyoscine bromide on the isolated distal colon of the guinea-pig: a comparison of their activities and mechanisms of action. J Pharm Pharmacol 1969; 21: 662-667
    CrossrefPubMedGoogle Scholar
  • 17 Maggi CA, Meli A. Assessment of potential selectivity of antispasmodics for the various sections of the gastrointestinal tract of the rat as a guideline for their clinical use. Arch Int Pharmacodyn Ther 1983; 262: 221-231
    PubMedGoogle Scholar
  • 18 Sasaki D, Kido A, Yoshida Y. Effect of antispasmodic drugs on colonic motility. Part I: Laboratory study of the dog. Int J Clin Pharmacol Ther Toxicol 1984; 22: 333-337
    PubMedGoogle Scholar
  • 19 Thompson DG, Wingate DL. Oral hyoscine butylbromide does not alter the pattern of small intestinal motor activity. Br J Pharmacol 1981; 72: 685-687
    CrossrefPubMedGoogle Scholar
  • 20 Herxheimer A, Haefeli L. Human pharmacology of hyoscine butylbromide. The Lancet 1966; 288: 418-421
    CrossrefPubMedGoogle Scholar
  • 21 Hellström K, Rosén A, Söderlund K. The gastrointestinal absorption and the excretion of H3-butylscopolamine (hyoscine butylbromide) in man. Scand J Gastroenterol 1970; 5: 585-592
    PubMedGoogle Scholar
  • 22 Neiger A, Bircher J. Treatment of functional abdominal distress. Double-blind test with Buscopan and Tranquo-Buscopan. Schweiz Med Wochenschr 1970; 100: 1237-1240
    PubMedGoogle Scholar
  • 23 De Gregorio M, Damiani S, Gatta G. Antalgic properties of proxazole. Double blind study in visceral algoplastic conditions. Panminerva Med 1969; 11: 436-440
    PubMedGoogle Scholar
  • 24 Ritchie JA, Truelove SC. Treatment of irritable bowel syndrome with lorazepam, hyoscine butylbromide, and ispaghula husk. Br Med J 1979; 1: 376-378
    CrossrefPubMedGoogle Scholar
  • 25 Mora Durban MJ, Extramiana Cameno J, Arrizabalaga Moreno M et al. Flubiprofen vs dipyrone combined with hyoscine: the analgesic efficacy in renal colic. Arch Esp Urol 1995; 48: 867-873
    PubMedGoogle Scholar
  • 26 al-Waili NS, Saloom KY. Intravenous tenoxicam to treat acute renal colic: comparison with buscopan compositum. J Pak Med Assoc 1998; 48: 370-372
    PubMedGoogle Scholar
  • 27 Watcha MF, Ramirez-Ruiz M, White PF et al. Perioperative effects of oral ketorolac and acetaminophen in children undergoing bilateral myringotomy. Can J Anaesth 1992; 39: 649-654
    CrossrefPubMedGoogle Scholar
  • 28 Innes GD, Croskerry P, Worthington J et al. Ketorolac versus acetaminophen-codeine in the emergency department treatment of acute low back pain. J Emerg Med 1998; 16: 549-556
    CrossrefPubMedGoogle Scholar
  • 29 Barber FA, Gladu DE. Comparison of oral ketorolac and hydrocodone for pain relief after anterior cruciate ligament reconstruction. Arthroscopy 1998; 14: 605-612
    PubMedGoogle Scholar