Diagnosis Of Acute Renal Colic Research Articles

Intranasal ketorolac and opioid in treatment of acute renal colic

The usual treatment of pain in acute renal colic is analgesic in intravenous (IV) route. We tried a rapid, non-painful, non-invasive route of administration using intranasal ketorolac plus fentanyl versus IV standard treatment with non steroidal anti-inflammatory drug plus opioid for the relief of pain in renal colic presenting patients to an Emergency Department (ED). We conducted a prospective nonblinded clinical trial. A sample of 82 adult patients with clinical diagnosis of acute renal colic was included to receive either intravenous ketorolac plus fentanyl or intranasal ketorolac plus fentanyl. Pain score was rated by using a 10 cm visual analogue scale at 0, 30 and 60 minutes after the treatment. Primary outcome was pain reduction. Secondary outcomes were adverse events and rescue treatment. Eighty-two patients were enrolled. The first forty-one patients received intranasal ketorolac plus fentanyl and the second forty-one received intravenous ketorolac plus fentanyl. There were not statistically significant differences in reduction of pain between the two groups at 30 and 60 minutes (P-value at 30=0,225; P-value at 60=0,312) although the trend was in favour of IV group. There were no significant differences between the groups with regard to secondary outcomes (adverse events and rescue treatment). Intranasal ketorolac and fentanyl are equivalent in analgesic effect to intravenous ketorolac and fentanyl treatment for ED patients with acute renal colic and the intranasal treatment can be considered a valid alternative to the standard intravenous treatment.

Sublingual buprenorphine for acute renal colic pain management: a double-blind, randomized controlled trial

BackgroundThe aim of this study was to compare the efficacy and safety of sublingual buprenorphine with intravenous morphine sulfate for acute renal colic in the emergency department.MethodsIn this double-dummy, randomized controlled trial, we enrolled patients aged 18 to 55 years who had a clinical diagnosis of acute renal colic. Patients received either 2 mg sublingual buprenorphine with an IV placebo, or 0.1 mg/kg IV morphine sulfate with a sublingual placebo. Subjects graded their pain with a standard 11-point numeric rating scale (NRS) before medication administration and 20 and 40 minutes after that. The need for rescue analgesia and occurrence of side effects were also recorded in the two groups.ResultsOf 69 patients analyzed, 37 had received buprenorphine, and 32 had taken morphine. Baseline characteristics were similar in both groups. NRS pain scores were reduced across time by administration of both buprenorphine (from 9.8 to 5.22 and then 2.30) and morphine (from 9.78 to 4.25 and then 1.8), significantly (P <0.0001). The two regimens did not differ significantly for pain reduction (P?=?0.260). Dizziness was more frequently reported by the buprenorphine group (62.1% versus 37.5%, P <0.05) but other adverse effects observed within 40 minutes were similar in the two groups.ConclusionsSublingual buprenorphine (2 mg) is as effective as morphine sulfate (0.1 mg/kg) in acute renal colic pain management.

Intranasal Fentanyl for Analgesia in Adults with Acute Renal Colic

Objectives: The usual treatment of pain in acute renal colic is analgesic in intravenous (IV) route. We tried a rapid, non painful, non-invasive route of administration using intranasal fentanyl versus IV standard treatment (non steroidal anti-inflammatory drug (NSAIDs) plus morphine) for the relief of pain in renal colic presenting to an Emergency Department (ED). Methods: We conducted a prospective non-blinded randomized clinical trial. A sample of 63 adult patients with clinical diagnosis of acute renal colic was included to receive either intravenous morphine (5 mg) plus ketorolac (30 mg) or intranasal fentanyl (3 μg/kg). Pain score were rated by using a 10 cm visual analogue scale at 0,30 and 60 minutes after the treatment. Primary outcome was pain reduction. Secondary outcomes were adverse events and rescue treatment. Results: Sixty-three patients were enrolled. Thirty patients received nasal fentanyl and thirty-three received intravenous morphine plus ketorolac. Morphine-ketorolac therapy was statistically significant more effective than nasal fentanyl therapy in visual analog scores at 30 minutes: the difference in mean visual analog scale between the two groups was 1.74 cm (95% confidence interval 0.29 to 3.2; P=0.018) at 30 minutes. There were not statistically significant differences between the two groups at 60 minutes. There were no significant differences between the groups with regard to secondary outcomes (adverse events and rescue treatment). Conclusions: A combination of intravenous morphine plus ketorolac offers pain relief superior to nasal fentanyl treatment for ED patients with acute renal colic.

Ureteritis Cystica: Important Consideration in the Differential Diagnosis of Acute Renal Colic

Ureteritis cystica is an uncommon cause of acute renal pain. The aetiology remains unclear and the diagnosis may be difficult to establish. We report the case of a 29 year old woman with a history of repeated urinary tract infections presenting with acute renal colic in the absence of lithiasis. We review the diagnostic tools available to make the diagnosis and the recent pertinent literature.

Paracetamol vs piroxicam to relieve pain in renal colic. Results of a randomized controlled trial

Purpose We tested whether paracetamol could improve pain relief in patients visiting the emergency department with acute renal colic as compared to piroxicam, a nonsteroidal anti-inflammatory drug (NSAID). Materials and Methods Patients with a diagnosis of acute renal colic were prospectively randomized to receive either intravenous paracetamol (1 g) or intramuscular piroxicam (20 mg). We monitored patients for visual analog scale (VAS), heart rate, arterial blood pressure, need for rescue therapy, and adverse events at different time points for 90 minutes. We recorded admission requirement and new visit for renal colic at 72 hours. The primary end point was pain relief at 90 minutes, defined as a decrease of 50% or more as compared to the initial VAS. The secondary objectives were comparison of the 2 groups for VAS at any time points and the occurrence of adverse events. Results Of the 226 eligible patients, 100 entered the study. Fifty patients received paracetamol and 50 received NSAID. Pain relief at 90 minutes was obtained in 40 patients receiving paracetamol (80%) and 24 (48%) receiving NSAID ( P = .002). Visual analog scale was lower in the paracetamol group since 45 minutes. Only 2 adverse events were observed. Conclusion A single therapy with intravenous paracetamol more efficiently relieved pain in acute renal colic than did intramuscular piroxicam.

Phloroglucinol as an adjuvant analgesic to treat renal colic

Purpose We tested whether the addition of phloroglucinol to piroxicam could improve pain relief in patients with acute renal colic visiting the emergency department. Materials and Methods Patients with a diagnosis of acute renal colic were prospectively randomized to receive intravenous phloroglucinol (200 mg) or placebo combined with intramuscular piroxicam (20 mg). We monitored the visual analogic scale (VAS), heart rate, arterial blood pressure, need for rescue therapy, and adverse events at different time points for 1 hour. We recorded admission requirement and new visit at 72 hours for renal colic. The primary end point was to assess pain relief at 1 hour, defined as a decrease of 50% or more as compared with the initial VAS. The secondary objectives were to compare the 2 groups for VAS at any time points, the need for rescue therapy, and the occurrence of adverse events. Results Of the 309 eligible patients, 253 entered the study. A total of 126 patients received phloroglucinol and 127 patients received placebo. Pain relief at 1 hour was obtained in 89 patients (71%) receiving phloroglucinol and 89 patients (70%) receiving placebo ( P = .89). There were no differences in VAS between the 2 groups at any time points. Rescue therapy was required in 37 patients (29%) receiving phloroglucinol and 38 patients (30%) receiving placebo ( P = .51). Number of adverse events was similar with phloroglucinol and placebo: 20 (16%) and 16 (13%), respectively ( P = .44). Conclusions There was no evidence that the addition of phloroglucinol improved the efficiency of piroxicam to relieve pain in acute renal colic.

IS THERE A ROLE FOR ANTIMUSCARINICS IN RENAL COLIC? A RANDOMIZED CONTROLLED TRIAL

We determined whether the addition of hyoscine butylbromide (Buscopan) reduces the amount of opioid analgesia required and the need for ongoing opioid analgesia in acute renal colic. Patients with a clinical diagnosis of acute renal colic were prospectively randomized to receive Buscopan or placebo in addition to morphine and intravenous fluids, with or without indomethacin. Observations and pain scores were recorded 15 every minutes during the first hour then hourly thereafter. Morphine was administered in 2.5 mg increments until pain relief was achieved. Recordings were ceased at 4 hours or on discharge from the emergency department, whichever occurred first. The diagnosis of renal colic was confirmed by computerized tomography. The dose of morphine (mg/kg) and the proportion of patients who required further morphine were compared between the 2 groups. Of the 192 patients randomized, data were available for 178 on an intent to treat basis. A total of 85 patients received Buscopan while 93 received placebo in addition to standard therapy. Patients in the Buscopan group required a median of 0.12 mg/kg of morphine while those in the placebo group received a median of 0.11 mg/kg, and this difference was not significant (p =0.4). There was also no significant difference in the proportion of patients who required additional morphine, 33% in the Buscopan group and 38% in the placebo group (p =0.5). Subgroup analysis of the 138 patients with a confirmed stone also showed no difference between the groups. There is no evidence that Buscopan reduces opioid requirements or the need for ongoing opioid analgesia in acute renal colic.

Usefulness of History-Taking, Physical Examination and Diagnostic Scoring in Acute Renal Colic

Objective: The accuracy of the clinical diagnosis of acute renal colic was studied in connection with the survey of acute abdominal pain by the Research Committee of the World Organization of Gastroenterology. The diagnostic efficiency of various clinical symptoms, signs and tests have not previously been analyzed in the diagnosis of acute renal colic, and therefore the study is of potential importance. Methods: 1,333 patients presenting with acute abdominal pain were included in the study. The clinical findings in each patient were recorded in detail, using a predefined structured data collection sheet, and the collected data were compared with the final diagnoses of the patients. Twenty-three clinical history variables, 14 clinical signs and 3 tests were evaluated in a single variable and multivariate analysis. Results: In multivariate logistic regression analysis, the most significant predictors of acute renal colic were urine, tenderness, renal tenderness, duration of pain and appetite. The sensitivity in detecting acute renal colic was 0.84, with a specificity of 0.99 and an efficiency of 0.98. To sum up the contributions of most significant diagnostic factors, a diagnostic score (DS) was built. This score incorporated independent variables, e.g. urine, tenderness, renal tenderness, duration of pain, appetite and sex. The DS reached a sensitivity of 0.89 in detecting acute renal colic, with a specificity of 0.99 and an efficiency of 0.99. Conclusions: The results clearly show that acute abdominal pain with normal appetite, short duration of pain (≤12 h), loin or renal tenderness and hematuria (erythrocytes >10) are indicative of acute renal colic, and therefore, in this particular clinical question, careful history-taking and physical examination are of utmost importance. In our study, the DS system performed well considering the simple nature of its structure. However, to minimize the risk to the patient, we recommend that the DS is used only as an aid in decision-making when there is uncertainty as to the diagnosis of acute renal colic and the need for immediate treatment. In addition, the possibility of obstructive pyelonephritis in combination with renal colic should be considered clinically.