Treatment Of Acute Renal Colic Research Articles

A Study on Pain Improvement Using Compound Diclofenac Sodium with Pethidine and Scopolamine in the Treatment of Acute Renal Colic

Objective: To analyze the improvement effect of compound diclofenac sodium with pethidine and scopolamine on patients’ pain in the treatment of acute renal colic. Methods: 360 patients with acute renal colic admitted from January 2022 to December 2023 were selected and divided into the control group and the observation group by double-blind method. The control group applied pethidine with scopolamine treatment and the observation group adopted the same treatment combined with compound diclofenac sodium. Comparison between the two groups was made in terms of pain improvement, the disappearance time of each symptom, as well as the treatment effect and adverse drug reactions. Results: The pain score of the observation group after treatment was lower than that of the control group, the disappearance time of each symptom was shorter than that of the control group, the total treatment effectiveness was higher than that of the control group (P < 0.05), and the difference in the incidence of adverse reactions between the two groups was not significant (P > 0.05). Conclusion: In the treatment of acute renal colic, the combined application of compound diclofenac sodium with pethidine and scopolamine can actively improve the pain symptoms and promote the disappearance of each symptom as early as possible, which is effective and has few adverse reactions.

Atomized Intranasal Ketorolac Versus Intravenous Ketorolac for the Treatment of Severe Renal Colic in the Emergency Department: A Double-Blind, Randomized Controlled Trial

Atomized intranasal (IN) drug administration offers an alternative to the intravenous (IV) route. We aimed to evaluate the analgesic efficacy of IN versus IV ketorolac in emergency department patients with acute renal colic. We conducted a double-blind, randomized controlled trial on adult patients (aged 18 to 64 years) with severe renal colic and numerical rating scale pain ratings ≥7.0. They were randomly assigned (1:1) to receive single doses of either IN or IV ketorolac. Our main outcomes were differences in numerical rating scale reduction at 30 and 60 minutes. A 95% confidence interval (CI) was calculated for each mean difference, with a minimum clinically important difference set at 1.3 points. Secondary outcomes included treatment response, adverse events, rescue medications, and emergency department revisits. We analyzed using intention-to-treat. A total of 86 and 85 patients with similar baseline characteristics were allocated to the IV and IN groups, respectively. Mean numerical rating scale scores were 8.52 and 8.65 at baseline, 3.85 and 4.67 at 30 minutes, and 2.80 and 3.04 at 90 minutes, respectively. The mean numerical rating scale reduction differences between the IV and IN groups were 0.69 (95% CI -0.08 to 1.48) at 30 minutes and 0.10 (95% CI -0.85 to 1.04) at 60 minutes. There were no differences in secondary outcomes. Neither IN or IV ketorolac was superior to the other for the treatment of acute renal colic, and both provided clinically meaningful reductions in pain scores at 30 to 60 minutes.

Comparison of acetaminophen, ketamine, or ketorolac versus morphine in the treatment of acute renal colic: A network meta-analysis

BackgroundRenal colic is a disease in which a calculus obstructs the urinary tract, resulting in severe pain do ureteric peristaltic movements. Other symptoms, such as hematuria, nausea, and vomiting, may accompany the pain. This network meta-analysis aimed to compare the efficacy and safety of different analgesic agents for the treatment of acute renal colic. MethodsMedline, Embase, and CENTRAL databases were searched. Randomized controlled trials (RCTs) that compared different analgesic agents, either alone or in combination were included. For the management of acute renal colic, analgesic agents were selected based on the current standard medical practice. The medications included intravenous acetaminophen, ketamine, ketorolac, and morphine. This study sought to evaluate the pain score on the visual analog scale (VAS) at 15, 30, and 60 min; adverse events; and the utilization of rescue therapy. The efficacy of different analgesic agents was explored through a frequentist network meta-analysis using the Netmeta statistical package in R software. All treatments were ranked using the Netrank function, yielding P-scores. ResultsTwelve RCTs were deemed eligible. As per the P-scores, acetaminophen was the most effective in reducing pain score at 15 min (P-score = 0.74). Ketorolac was the most effective in reducing the pain score at 30 and 60 min (P-score = 0.84) (P-score = 0.99), whereas morphine was the least effective (P-score = 0.07). Moreover, morphine was correlated with the highest odds of adverse events after treatment (P-score = 0.89). Morphine was the most frequently required rescue therapy in cases of suboptimal pain relief (P-score = 0.96). ConclusionThis network meta-analysis demonstrated that ketorolac and acetaminophen were the most effective analgesic agents according to the pain score. Morphine showed the highest adverse event profile and the highest rate at which rescue therapy was required for the management of acute renal colic.

Comparison of the Efficacy of Nonsteroidal Anti-Inflammatory Drugs and Opioids in the Treatment of Acute Renal Colic: A Systematic Review and Meta-Analysis.

Background: Although multiple randomized controlled trials (RCTs) and systematic review and meta-analysis were performed to investigate the efficiency and safety of nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids in the treatment of acute renal colic, the therapeutic regimen of renal colic is still controversial. Therefore, the aim of this study was to derive a more concise comparison of the effectiveness and safety between NSAIDs and opioids in the treatment for patients with acute renal colic by a systematic review and meta-analysis. Design: We searched PubMed, Embase, and Cochrane Central Register of controlled trials for seeking eligible studies. The pooled mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI) was calculated using the random effects model. The primary outcome was assessed according to the Grading of Recommendations Assessment, Development and Evaluation. Results: A total of 18 studies involving 3,121 participants were included in the systematic review and meta-analysis. No significant difference between the NSAID and opioid groups was observed, with changes in the visual analog scale (VAS) at 0–30 min (MD = 0.79, 95% CI: −0.51, 2.10). NSAIDs in the form of intravenous administration (IV) had no better effect on the changes in the VAS at 0–30 min, when compared to opioids (MD = 1.25, 95% Cl: −4.81, 7.3). The NSAIDs group in the form of IV had no better outcome compared to the opioids group, as well as the VAS at 30 min (MD = −1.18, 95% Cl: −3.82, 1.45; MD = −2.3, 95% Cl: −5.02, 0.42, respectively). Moreover, similar results of this outcome were also seen with the VAS at 45 min (MD = −1.36, 95% Cl: −5.24, 2.52). Besides, there was a statistical difference in the incidence of later rescue (RR = 0.76, 95% CI: 0.66, 0.89), drug-related adverse events (RR = 0.44, 95% CI: 0.27, 0.71), and vomiting (RR = 0.68, 95% CI: 0.49, 0.96). Conclusion: There is no significant difference between the NSAIDs and opioids in the treatment of renal colic in many outcomes (e.g., the VAS over different periods using different injection methods at 30 and 60 min), which has been focused on in this study. However, the patients who were treated using NSAIDs by clinicians can benefit from fewer side effects.

Parecoxib Vs Paracetamol for Treatment of Acute Renal Colic Due to Ureteric Calculi: A Randomized Controlled Trial

To compare efficacy and safety of parecoxib and paracetamol for treatment of acute renal colic due to ureteric stones. A randomized, double blinded, controlled trial included adult patients presented to emergency department with acute renal colic due to ureteric calculi between June 2019 and August 2020. Patients with hypersensitivity to either drug, peptic ulcer, coronary ischemia, peripheral vascular or cerebrovascular disease, hepatic impairment (Child-Pugh score >10) or chronic kidney disease stage 4 or 5 were excluded. Eligible patients were randomized to group 1 who received 1g intravenous Paracetamol infusion or group 2 who received 40mg intravenous Parecoxib infusion. Pain analogue score was evaluated before treatment and 30 minutes afterwards. The primary endpoint was the need for rescue analgesia for persistent pain. Safety was evaluated by the incidence of adverse events. The study included 203 patients (102 in group 1 and 101 in group 2). Pretreatment patients' data were comparable for both groups. The mean pain analogue score decrease from 7.6 to 3.8 in paracetamol group (P <.001) and from 7.8 to 3.4 in parecoxib group (P <.001). Rescue analgesia were needed in 36 patients (35.3%) in paracetamol group and 27 patients (26.7%) in parecoxib group (P=.187). Minor adverse events developed in 2 patients (2%) in paracetamol group and 3 patients (3%) in parecoxib group (P=0.683). Paracetamol and Parecoxib were effective for treatment for patient with acute renal colic. Both treatments showed comparable results in reduction of pain and need for rescue analgesia with minimal adverse events.

Sub-Dissociative Ketamine Use in the Emergency Department for Treatment of Suspected Acute Nephrolithiasis: The SKANS Study

CONTEXTCurrently, there is no standard therapy for treatment of acute renal colic. With the increased scrutiny and controversy now surrounding opioids, the authors identified a need to investigate an alternative medication for pain control. As such, they sought to determine the efficacy of sub-dissociative (i.e., low) doses (0.3 mg/kg) of ketamine in providing Emergency Department (ED) patients acute pain management for renal colic secondary to nephrolithiasis.METHODSAfter institutional review board (IRB) approval, the authors conducted a non-blinded, prospective clinical study. A convenience sample of n = 34 patients from the ED of a Western Michigan-based health system with suspected renal colic received one intravenous dose of ketorolac, 30 mg if over 50 kg body weight or 15 mg if under 50 kg In patients weighing greater than 50 kg, up to two doses of sub-dissociative ketamine were then given to further control pain. Pain was assessed at times 0, 30, 60, 90 and 120 minutes.RESULTSThere was a statistically significant pain reduction with administration of sub-dissociative ketamine, with 24 (69.2%) patients reporting an average reduction in pain score > 30% (t = 3.16, p = 0.004). Initial average pain scores for patients receiving sub-dissociative ketamine averaged 7.76 (SD = 2.55) on the 11-point verbal Pain Numeric Rating Scale. After a first dose of ketamine, patients’ average pain score was 3.56 (SD = 0.74) at 30 minutes. After two hours, patients’ average score was 2.56 (SD = 0.65), indicating that pain control was still effective over time with no statistically significant change in pain scores. Additionally, there was no statistically significant difference in pain reduction observed between genders (t = -0.192, p = 0.850).CONCLUSIONSBased on these results, sub-dissociative ketamine may be considered a reasonable and effective supplemental non-opiate treatment option for suspected renal colic in otherwise healthy 18-70-year-old patients and could provide an effective alternative to traditional therapies. Further studies utilizing this methodology with larger, more generalizable samples are needed to further validate these findings.

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.

Comparative Efficacy and Safety of Nonsteroidal Anti-Inflammatory Drugs, Opioids, and Paracetamol in the Treatment of Acute Renal Colic: A Network Meta-Analysis of Randomized Controlled Trials Based on Three-Stage Study Design

Background: The evidence of different analgetics for acute renal colic was uncertain. We aimed to comprehensively assess the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs), opioids, paracetamol, combination therapy, and placebo for treatment of acute renal colic. Methods: We did a systematic review and network meta-analysis. We searched Ovid MEDLINE, Ovid EMbase, the Cochrane Library, Clinical Trials Registry Platform for Clinicaltrials.gov, and WHO International Clinical Trials Registry Platform through February 2, 2018. All randomised controlled trails (RCTs) regarding NSAIDs, opioids, paracetamol, combination therapy, and placebo were identified for analysis. In network meta-analysis, we used group-level data. The primary outcome was pain variance at 30 min. To obtain the most reliable results, we designed a three-stage strategy based on classification and pharmacological mechanisms in the first stage, routes of administration in the second stage, and specific drug branches with different routes in the third stage. We estimated summary odds ratios (ORs) using pairwise and network meta-analysis with fixed and random effects. Findings: We identified 65 studies with 8633 participants for analysis. In the first stage, we found that combination therapy was more efficient than NSAIDs for the primary outcomes at the cost of safety. Opioids gave rise to more nonspecific adverse events and vomiting events compared with other interventions. NSAIDs were superior to opioids, paracetamol, combination therapy and placebo after a full consideration of all outcomes. In the second stage, NSAIDs sused with an intravenous (IV) route or intramuscular (IM) route ranked first in all interventions with different routes from an efficacy or safety perspective, respectively. In the third stage, ibuprofen used with an IV route, ketorolac with an IV route and diclofenac with an IM route were superior for the management of acute renal colic. The results from diclofenac using the IM route were more reliable than those from ibuprofen used with an IV route and ketorolac with an IV route. Interpretation: This network meta-analysis suggests that NSAIDs are superior to opioids, paracetamol, combination therapy and placebo and NSAIDs with the IV route or IM route ranked the highest. Furthermore, our study recommends that diclofenac used with an IM route as more reliable results for the management of acute renal colic for patients who do not have risks of cardiovascular events. For other patients with risks of cardiovascular events, different NSAIDs could be used or diclofenac IM could be used after careful consideration. Because there were only a few studies, the results of ibuprofen using the IV route and ketorolac using the IV route need to be verified. Trial Registration No.: This study is registered with PROSPERO, number CRD42018087906. Funding: None. Conflict of Interest: We declare no competing interests.

Emergency extracorporeal shockwave lithotripsy as opposed to delayed shockwave lithotripsy for the treatment of acute renal colic due to obstructive ureteral stone: a prospective randomized trial.

The aim of this study was to assess the efficacy of emergency extracorporeal shockwave lithotripsy (eSWL) as first-line treatment in patients with acute colic due to obstructive ureteral stone. Seventy-four patients were randomized to emergency SWL within 12 hours (eSWL group) and deferred SWL later than 3 days (dSWL group). Follow-up included ultrasound, KUB (kidney-ureter-bladder) radiography and CT (computed tomography) scan at 24 hours, 7 days, 1 and 3 months from the treatment. When necessary, repeated SWL (re-SWL) or ureteroscopy (auxiliary-URS) was performed. Preoperative and postoperative data were compared and stone free rates (SFR) and efficiency quotients (EQ) were evaluated. Analyses were performed using SAS software. Complete data of 70 patients were collected. 36 underwent eSWL and 34 dSWL. The mean patient age was 48.7. Mean stone size was 9.8 mm (CI 95%: 8.9-10.8). 25 (35.7%) were proximal and 45 (64.3%) distal. Mean SWL energy was 19.2 kV (CI 95%: 18.5-19.9) and mean number of shocks was 2657 (CI 95%: 2513-2802). eSWL patients needs less auxiliary-URS than dSWL patients (13.9% vs. 44.1%, P=0.039) and less re-SWL sessions (8.3% vs. 32.4%, P=0.093). SFR at 24 hours was 52.8% and 11.8% (P<0.001) and the EQ at 3 months was 79.1% and 57.5% in the eSWL and dSWL group respectively. Patients from the dSWL group spent more time in the hospital (2.21 vs. 1.36 days, P=0.046) and complication rates between the two groups were similar. eSWL is a safe procedure and delivers high SFR even within 24 hours especially for <10 mm stones. It is able to reduce the number of auxiliary procedures and hospitalization.

Randomized double blinded placebo controlled trial comparing diclofenac and piroxicam in management of acute renal colic and its clinical implications.

To compare the efficacy of sublingual piroxicam 40 mg with intramuscular diclofenac 75 mg in treatment of acute renal colic. The secondary objective was to look for factors that can affect the severity of the pain and pain relief in acute renal colic. One hundred patients with acute renal colic were randomized into two groups. Group A (n = 50) received intramuscular diclofenac and sublingual methylcobalamin. Group B (n = 50) received sublingual piroxicam 40 mg and intramuscular distilled water. Pain severity was measured using Visual Analog Scale (VAS) and verbal and facial response scales. They were followed up for 3 h. Intramuscular injection of pentazocine 30 mg with promethazine 25 mg were used as rescue drugs. Both groups were comparable for age, sex distribution, body mass index (BMI), and pain duration before presentation. Significant pain relief was noticed in both groups. Sixteen percent in group A and 18% in group B had complete pain relief within 30 min (P = .75). Fifteen patients in group A and 13 patients in group B needed rescue drugs, 84% of group A and 76% of group B had complete pain relief at the end of 3 hours (P = .25). Decrease in pain by each scoring method was also comparable (P = .75). In multiple regression analysis, increasing age, positively affects the severity of pain and pain relief while increasing BMI negatively affect the initial pain relief. Acute renal colic seems to affect men more commonly than women, 81% of the study population were men. Patients with low initial pain score did not require any additional pain relief. Average pain duration before presenting to hospital is 260 min. Sixty percent of renal colics are due to stones below pelvic brim. The results show that sublingual piroxicam is as effective as intramuscular diclofenac. It can be easily self-administered and it overcomes the morbidity and time delay in getting intramuscular diclofenac.

S060: Comparison of the analgesic effects of dexketoprofen and diclofenac for the treatment of acute renal colic

S060: Comparison of the analgesic effects of dexketoprofen and diclofenac for the treatment of acute renal colic

Combining 1000 mg oral acetaminophen with 75 mg intramuscular Diclofenac of analgesic efficacy for acute renal colic treatment

In this study, we compared oral acetaminophen alone versus intramuscular diclofenac alone versus both together in the treatment of acute renal colic. A prospective, randomized, and double-blind study was conducted in the Emergency Department. Patients were divided into three groups, which were given either acetaminophen + placebo (n = 25), diclofenac sodium + placebo (n = 25) or acetaminophen + diclofenac sodium (n = 25). Pain was evaluated by means of VAS of 100 mm. We monitored patients for visual analog scale (VAS), need for rescue therapy, and adverse events at different time points to at 15, 30 and 60 min. Result of the 183 eligible patients, 75 entered the study. VAS pain scores and demographic data of all three groups were similar before the medical procedure (p > 0.05). No significant differences between VAS pain scores obtained soon after the application of acetaminophen or diclofenac at the 15th, 30th and 60th min were observed (p > 0.05). However, a significant difference in the VAS pain scores of the group to which the combination of acetaminophen + diclofenac was administered was observed compared to the acetaminophen group (p < 0.01). Rescue analgesics at 30 min were required by 6 (24%) subjects receiving acetaminophen, 2 (8%) subjects receiving diclofenac and 2 (8%) subjects receiving combination group. No side effects were detected. The combination of acetaminophen and diclofenac is more effective than acetaminophen alone in patients with renal colic. Orally paracetamol was not effective in treatment renal colic. Key words: Acetaminophen, diclofenac, colic, kidney calculi, emergency treatment.

Analgesic Drugs Combinations in the Treatment of Different Types of Pain

Pain relief can be achieved by a diversity of methods, with drug use being the basis of analgesic treatment. Clinical use of combinations of analgesic drugs has augmented considerably in the last few years. The purpose of combining two or more drugs with different mechanisms of action is to achieve a synergistic interaction [1], yielding a sufficient analgesic effect with lower doses, and, therefore, reduce the intensity and incidence of untoward effects. At present, many diverse classes of drugs serve as an efficient complement to nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen or opioids, in the management of pain. But we emphasize that the success of a drug combination depends on the type of pain that is targeted (acute/chronic, inflammatory, neuropathic, cancer). Thus, opioids have frequently been used in combination with acetaminophen or NSAIDs for the clinical management of both acute and chronic pain. Likewise, the NSAIDs-acetaminophen combination has been administered to patients to relief the pain. At the end, the use of these combinations limits the doses of medication that a patient can receive. However, not all the opioid-NSAID, opioid-acetaminophen, or NSAID-acetaminophen combinations are clinically successful in all cases. For example, the association of weak opioids, such as dextropropoxyphene, to acetaminophen does not significantly increase pain relief compared to acetaminophen alone [2]. The administration of rectal acetaminophen combined with ibuprofen does not improve analgesia after adenoidectomy in the immediate postoperative period compared with either drug alone [3]. Likewise, the combination of codeine with paracetamol results in additional pain relief but may be accompanied by an increase in nausea, dizziness, vomiting, and constipation [4]. Therefore, several other combinations of analgesic agents must be evaluated experimentally or clinically to gain insight into their potential clinical use. In this sense, different combinations have been suggested. In the present special issue, a study realized by H. A. Ponce-Monter et al. showed that the diclofenac plus B vitamins combination was more effective to reduce the pain than diclofenac alone. Authors conclude that the combination of diclofenac plus B vitamins could be a safe and inexpensive postsurgical analgesic strategy. In the present issue, A. Porwal and coworkers showed how different drug combinations may not be equally effective in an acute pain model; in a large study population, they in fact compared diclofenac and dicyclomine injection to a combination of dexketoprofen and dicyclomine for the treatment of acute renal colic and provided evidence that the latter was significantly more effective and tolerable than the former drug combination. On the other hand, A. Hama and J. Sagen, in a comprehensive review of the available preclinical and clinical studies, illustrate the pharmacological and physiological mechanisms that justify the use of a combined drug therapy for the treatment of neuropathic pain due to spinal cord injury. The authors point out how a combination drug treatment strategy, wherein several pain-related mechanism are simultaneously engaged, may be more efficacious than treatment against individual mechanisms alone, being possible to reduce the doses of the individual drugs, thereby minimizing the potential for adverse side-effects. Clinicians should be conscious about the benefits and risks of the drugs combination in the management of pain. Also, physicians must be aware that NSAIDs can cause potentially serious adverse effects when used in combination with other common medications such as anticoagulants, corticosteroids, or antihypertensive agents. Finally, patients should be properly counseled on the appropriate and safe use of the combination of analgesics. Mario I. Ortiz Maria Asuncion Romero Molina Young-Chang P. Arai Carlo Luca Romano

Intramuscular Drotaverine and Diclofenac in Acute Renal Colic: A Comparative Study of Analgesic Efficacy and Safety

To evaluate the analgesic efficacy and safety of intramuscular drotaverine hydrochloride vs diclofenac sodium in treatment of acute renal colic. We conducted a randomized, single-blind study comparing single intramuscular doses of drotaverine hydrochloride (80 mg) vs diclofenac sodium (75 mg) on 100 patients (50 in each arm) presenting to the emergency department (ED) with renal colic. Subjects with inadequate pain relief at 30 minutes received rescue intramuscular tramadol (100 mg). Pain intensity was recorded using a visual analog scale (VAS), which is the primary outcome measure of this study, before drug administration and 30 and 60 minutes afterwards. The drug effectiveness was defined as ≥50% decrease in pain intensity 60 minutes after intramuscular administration, without exacerbation during the following 2 hours. The need for rescue medication and the presence of adverse effects were considered as secondary outcome of the study. VAS decreased significantly (P < 0.001) with both drotaverine (52.4%) and diclofenac (49%) at 30 minutes. Reduction of VAS at 60 minutes was 61.3% with drotaverine in comparison to 60.4% with diclofenac. Forty-five patients (90%) in the drotaverine group and 44 (88%) in the diclofenac group found the therapy effective. The need for rescue medication was in five patients of the drotaverine group and six patients in the diclofenac group. There was no significant difference in safety profile in the study groups. The efficacy and safety of drotaverine as analgesic in renal colic is noninferior to diclofenac and may be used as an alternative or add-on therapy to currently available options.

Butylscopolammonium bromide does not provide additional analgesia when combined with morphine and ketorolac for acute renal colic

To evaluate the effect of adding butylscopolammonium bromide (BB) to morphine and ketorolac in the treatment of acute renal colic in the ED. A prospective, double-blind, randomized controlled trial of i.v. triple therapy (morphine, ketorolac and BB) versus double therapy (morphine and ketorolac) in adult ED patients with a clinical diagnosis of acute renal colic and a pain rating greater than five on a 10 cm visual analogue scale (VAS). VAS was recorded at time 0, 20 and 40 min. Patients received rescue morphine at 20 or 40 min according to the protocol if needed. We compared pain reduction and the need for rescue analgesia at 4 min between two groups. Eighty-nine patients were randomized over a 13 month period. A total of 46 (51.7%) patients received BB in addition to morphine and ketorolac. The mean difference in change in pain score in the triple therapy group and double therapy group was 7.1 cm (95% CI 6.4-7.8) and 5.9 cm (95% CI 5.1-6.7), respectively (P= 0.024). Rescue morphine was required by 7/46 (15.2% [95% CI 4.4-20.6]) patients in the triple therapy group and 14/43 (32.6% [95% CI 18.0-47.1]) in the double therapy group (OR 0.37 [95% CI 0.133-1.038]). Although the addition of BB to morphine and ketorolac appeared to show a statistically significant reduction in pain compared with morphine and ketorolac alone, a reduction of 1.2 cm on VAS is unlikely to be clinically significant.

Effects of a non‐selective COX inhibitor and selective COX‐2 inhibitors on contractility of human and porcine ureters in vitro and in vivo

Anti-inflammatory drugs are used in the treatment of acute renal colic. The aim of this study was to investigate the effects of selective COX-2 inhibitors and the non-selective COX inhibitor diclofenac on contractility of human and porcine ureters in vitro and in vivo, respectively. COX-1 and COX-2 receptors were identified in human ureter and kidney. Human ureter samples were used alongside an in vivo pig model with or without partial ureteral obstruction. COX-1 and COX-2 receptors were located in human ureters by immunohistochemistry. Diclofenac and valdecoxib significantly decreased the amplitude of electrically-stimulated contractions in human ureters in vitro, the maximal effect (Vmax) being 120 and 14%, respectively. Valdecoxib was more potent in proximal specimens of human ureter (EC50=7.3 x 10(-11) M) than in distal specimens (EC50=7.4 x 10(-10) M), and the Vmax was more marked in distal specimens (22.5%) than in proximal specimens (8.0%) in vitro. In the in vivo pig model, parecoxib, when compared to the effect of its solvent, significantly decreased the maximal amplitude of contractions (Amax) in non-obstructed ureters but not in obstructed ureters. Diclofenac had no effect on spontaneous contractions of porcine ureter in vivo. COX-1 and COX-2 receptors were found to be expressed in proximal and distal human ureter and in tubulus epithelia of the kidney. Selective COX-2 inhibitors decrease the contractility of non-obstructed, but not obstructed, ureters of the pig in vivo, but have a minimal effect on electrically-induced contractions of human ureters in vitro.

Intravenous Morphine Plus Ketorolac Is Superior to Either Drug Alone for Treatment of Acute Renal Colic

To study the efficacy of intravenous ketorolac, morphine, and both drugs in combination in reducing pain in acute renal colic. We conducted a prospective, double-blinded, randomized controlled trial in an urban, teaching emergency department. Patients aged 18 to 55 years and with a clinical diagnosis of acute renal colic and a pain rating greater than 5 on a 10-cm visual analogue scale or at least "moderate pain" on a 4-category verbal pain scale were eligible for inclusion. Exclusion criteria were contraindication to nonsteroidal anti-inflammatory drugs or opiates, a history of drug dependence, presence of peritonitis, or analgesics within 6 hours of presentation. Patients received either morphine 5 mg at time zero and 5 mg at 20 minutes, ketorolac 15 mg at time zero and 15 mg at 20 minutes, or a combination of both. Primary outcomes were pain reduction and the need for rescue analgesia at 40 minutes. Of the 555 consecutive patients screened, 158 patients met inclusion criteria and 130 patients were randomized during 6 months. Mean difference in change in pain score (visual analog scale 40 minutes minus visual analog scale 0 minutes) between combination group and morphine group was 1.8 cm (95% confidence interval [CI] -3.3 to -0.1) and, compared to the ketorolac group, was 2.2 cm (95% CI -3.7 to -0.5); P<.003. Patients with combination therapy were less likely to require rescue morphine compared to the morphine group (odds ratio 0.2; 95% CI 0.1 to 0.7; P=.007). A combination of morphine and ketorolac offered pain relief superior to either drug alone and was associated with a decreased requirement for rescue analgesia.

Systematic Review of the Relative Efficacy of Non-Steroidal Anti-Inflammatory Drugs and Opioids in the Treatment of Acute Renal Colic

No AccessJournal of UrologyUrological Survey: Socioeconomic Factors, Urological Epidemiology And Practice Patterns1 May 2005Systematic Review of the Relative Efficacy of Non-Steroidal Anti-Inflammatory Drugs and Opioids in the Treatment of Acute Renal Colic Peter C. AlbertsenM.D. Peter C. AlbertsenPeter C. Albertsen More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000159634.93151.1eAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Systematic Review of the Relative Efficacy of Non-Steroidal Anti-Inflammatory Drugs and Opioids in the Treatment of Acute Renal Colic." The Journal of Urology, 173(5), p. 1706 © 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 173Issue 5May 2005Page: 1706 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.MetricsAuthor Information Peter C. Albertsen More articles by this author Expand All Advertisement PDF downloadLoading ...

Review: Nonsteroidal antiinflammatory drugs provide better pain relief than do opioids for acute renal colic

Source Citation Holdgate A, Pollock T. Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic. BMJ. 2004;328:1401-8. 1...

Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic

Objective To examine the relative benefits and disadvantages of non-steroidal anti-inflammatory drugs (NSAIDs) and opioids for the management of acute renal colic.Data sources Cochrane Renal Group's specialised register, Cochrane central...