OGBN P25 A systematic review and clinical evaluation of Morphine Versus pethidine as a good drug choice to control for biliary colic before and after cholecystectomy

Abstract

Abstract Background The most commonly recommended pharmaceuticals for biliary and pancreatic pain are arguably morphine and pethidine, both of which can elicit varying effects at the gallbladder, common bile duct, and sphincter of Oddi levels. Morphine stimulates Oddi's sphincter motility, causing upper abdominal pain and biliary distress symptoms in certain patients. Pethidine is thought to have less consequences on the sphincter of Oddi than morphine. This analysis aims to evaluate the comparative outcomes and effect of morphine versus pethidine on the sphincter of Oddi and biliary colic control. Methods A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library and Science Direct. Comparative studies comparing effect of morphine versus pethidine on sphincter of Oddi pressure were included. Revman 5.4 (Cochrane, London, United Kingdom) was used for the data analysis. Results The results show four studies were eligible to be included in this review with a total number of 151 patients divided between morphine group (n=111) and pethidine group (n=40). Two prospective studies and two clinical trials were included in this review. The rate of sphincter of Oddi pressure was significantly higher in morphine group compared to pethidine group: odds ratio (OR)=1.39, and (OR) =7.82, p=0.005, respectively. Conclusions The analysis shows significant difference in sphincter of Oddi pressure when morphine used as analgesic drug to control the biliary colic compared to pethidine which seems to provide low pressure at the level of sphincter of Oddi and good control of biliary colic than morphine, however more studies and clinical trials are needed.