MP22-18 EFFECT OF PRE-EMPTIVE INTRAMUSCULAR KETOROLAC ON POST-STENT COLIC

Abstract

INTRODUCTION AND OBJECTIVE: Ureteroscopy (URS) for stones is associated with post-operative morbidity largely attributed to ureteral stents. Stent removal may precipitate debilitating renal colic within minutes to hours. We performed a prospective, double-blind placebo-controlled, randomized trial evaluating the effect of intramuscular (IM) ketorolac administered at time of stent removal. METHODS: After obtaining institutional review board approval, consecutive eligible patients who underwent URS/stent for stones were enrolled in a prospective, RCT. Patients in whom ketorolac is contraindicated (diabetes, elevated creatinine, NSAID allergy) were excluded from study. Patients were randomized via computer-based random sequence generator to receive an IM injection of 30mg in 1mL of ketorolac or 1mL of 0.9% normal saline immediately prior to office stent removal. The patient, doctor and nurse administering the injection were blinded to the contents of the syringes. Demographic, operative and post-stent data were collected prospectively. Patients were contacted by a blinded research associate 24 hours and 7 days following stent removal to assess level of pain using a visual analog pain scale (VAS); the occurrence of renal colic symptoms; use of narcotics; Emergency Department (ED) or unplanned clinic visits; or need for surgical/medical interventions related to renal colic were recorded. Student’s t-test and Fischer Exact test were used for statistical analysis. RESULTS: A total of 124 patients (62 patients each in the control and treatment arms) were included. Demographics, operative characteristics and stent duration were comparable (p > 0.05). No difference between the groups was detected in mean VAS pain scores at 24 hours and 7 days, and no injection site reactions or complications occurred in either group. Administration of ketorolac resulted in significantly fewer renal colic-related ED/unplanned clinic visits in the treatment group (2%) compared to the control group (13%) (p = 0.032) (table). CONCLUSIONS: Although administration of ketorolac prior to stent removal did not result in reduction of post-stent pain on average, it did reduce the likelihood of severe renal colic requiring ED or office visits. Patients may benefit from routine pre-emptive ketorolac injection at the time of stent removal.Source of Funding: None