Comparing intranasal ketamine with intravenous fentanyl in reducing pain in patients with renal colic: A double-blind randomized clinical trial

Mozafari, Javad; Verki, Mohammadreza Maleki; Motamed, Hassan; Sabouhi, Alireza; Tirandaz, Fatemeh

doi:10.1016/j.ajem.2019.05.049

Cited by 15 publications

(15 citation statements)

References 18 publications

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“…Finally, intranasal ketamine increased patient satisfaction. This is inconsistent with the recent findings that intranasal ketamine can be helpful when accompanied by other medications (16). One explanation for this difference can be the administration of different drugs in control group.…”

Section: Discussioncontrasting

confidence: 71%

Intranasal Ketamine Versus Intravenous Ketorolac for Pain Control in the Renal Colic: A Randomized Clinical Trial Study

Khavanin

Moezzi

Motamed

et al. 2021

Jundishapur J Chronic Dis Care

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Background: Renal colic is one of the most common complaints among patients referring to the emergency department (ED). Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are gold standards to relieve pain. Objectives: The aim of this study was to evaluate the effects of intranasal Ketamine on pain control versus Ketorolac. Methods: In this randomized clinical trial (RCT), the patients were randomly assigned into two groups. While Ketorolac 30 mg was given intravenously to all patients in the control group, the patients in intervention group received 1 mg/kg drops of Ketamine intranasally. Pain severity, vital signs, and adverse events (AEs) were recorded after 60 min post-dose. Results: A total of 100 patients were enrolled in this study. The mean visual analog scale (VAS) score after the first 5 min was lower in the intranasal Ketamine group compared to control (5 ± 2.26 vs. 8.62 ± 0.49, respectively; P < 0.001), which remained significant at the end of 60th min (P < 0.001). Moreover, additional analgesics administration was higher in intravenous Ketorolac than intranasal Ketamine (22 vs 0%), which was significantly different (P = 0.001). Patients' satisfaction was higher in the intranasal Ketamine group compared to control (3.56 ± 0.35 vs. 1.82 ± 0.98, respectively; P < 0.001). Conclusions: Intranasal Ketamine was beneficial in controlling renal colic-induced pain, which could be prescribed as a treatment instead of normal treatment. It can rapidly improve pain relief in the short term, has lower AEs, and increases the patients' satisfaction.

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Section: Discussioncontrasting

confidence: 71%

Intranasal Ketamine Versus Intravenous Ketorolac for Pain Control in the Renal Colic: A Randomized Clinical Trial Study

Khavanin

Moezzi

Motamed

et al. 2021

Jundishapur J Chronic Dis Care

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“…After removing 269 studies (non-human studies (n = 4), review articles (n = 42), case reports (n = 16), duplicate studies (n = 207)), another 512 studies were excluded based on their abstracts as they did not comply with the objective and inclusion criteria of this study. Finally, seven RCTs [20,22,[31][32][33][34][35] with a total of 1760 participants were included in this SRMA (Figure 1).…”

Section: Study Selectionmentioning

confidence: 99%

Efficacy and Safety of Intranasal Ketamine for Acute Pain Management in the Emergency Setting: A Systematic Review and Meta-Analysis

Seak

Nor

Kamauzaman

et al. 2021

JCM

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Due to overcrowding, personnel shortages, or problematic intravenous (IV) cannulation, acute pain management is often sub-optimal in emergency departments (EDs). The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of intranasal (IN) ketamine for adult acute pain in the emergency setting. We searched and identified studies up to 21 May 2021 via PubMed, Scopus, Web of Science, Cochrane Database, and Google Scholar. The random-effects model with 95% confidence intervals (CIs) was used to estimate mean differences (MDs) and odds ratios (ORs). The I2 statistic and Cochran’s Q test were used to determine heterogeneity. The protocol was registered in PROSPERO (CRD42020213391). Seven randomised controlled trials were included with a total of 1760 patients. There was no significant difference in pain scores comparing IN ketamine with IV analgesics or placebo at 5 (MD 0.94, p = 0.26), 15 (MD 0.15, p = 0.74), 25 (MD 0.24, p = 0.62), 30 (MD −0.05, p = 0.87), and 60 (MD −0.42, p = 0.53) minutes. There was also no significant difference in the need for rescue analgesics between IN ketamine and IV analgesics (OR 1.66, 95% CI: 0.57−4.86, p = 0.35, I2 = 70%). Only mild adverse effects were observed in patients who received IN ketamine. Our results suggest that IN ketamine is non-inferior to IV analgesics and may have a role in acute pain management among adults in the ED.

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“…Just like opioids, NSAIDs are not innocent either in terms of their adverse effects. Additionally, various agents, such as paracetamol, ketamine, calcium channel blockers, alpha blockers, vasopressin analogues and magnesium sulphate, were used for analgesic management of acute renal colic 3‐5 . In addition to these medical treatments, such regional analgesic techniques as trigger point injection, 6 12th intercostal nerve block, 7 and subcutaneous paravertebral block 8 were also employed.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, various agents, such as paracetamol, ketamine, calcium channel blockers, alpha blockers, vasopressin analogues and magnesium sulphate, were used for analgesic management of acute renal colic. [3][4][5] In addition to these medical treatments, such regional analgesic techniques as trigger point injection, 6 12th…”

mentioning

confidence: 99%

Erector spinae plane block vs non‐steroidal anti‐inflammatory drugs for severe renal colic pain: A pilot clinical feasibility study

et al. 2020

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Aim Ultrasound‐guided plane blocks are increasingly used in the multi‐modal analgesic concept for reducing opioid consumption. The present study was conducted to compare the analgesic effect of intravenous non‐steroidal anti‐inflammatory drugs (NSAIDs) and erector spinae plane (ESP) block in renal colic patients. Methods In this prospective randomised study, 40 patients with renal colic pain were randomly assigned into two groups: Group NSAID (n = 20) received an intravenous infusion of 50 mg of dexketoprofen trometamol and Group ESP (n = 20) received ultrasound‐guided ESP block with 30 ml 0.25% bupivacaine at the T8 level. The pain severity of patients was assessed using the visual analogue scale (VAS) at baseline, 5, 15, 30, 45 and 60 minutes after intervention. Opioid consumption, patient satisfaction and side effects were recorded. Results In the ESP group, the VAS scores were significantly lower than the NSAID group at 5, 15, 30, 45 and 60 minutes after the procedure (P < .001). Opioid consumption was significantly higher in the NSAID group compared with the ESP group (10/20 vs 0/20, respectively; P < .001). Patient satisfaction was significantly higher in the ESP group (P < .001). Conclusions ESP block can be an alternative, efficient and safe method for the relief of acute renal colic pain.

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Comparing intranasal ketamine with intravenous fentanyl in reducing pain in patients with renal colic: A double-blind randomized clinical trial

Cited by 15 publications

References 18 publications

Intranasal Ketamine Versus Intravenous Ketorolac for Pain Control in the Renal Colic: A Randomized Clinical Trial Study

Intranasal Ketamine Versus Intravenous Ketorolac for Pain Control in the Renal Colic: A Randomized Clinical Trial Study

Efficacy and Safety of Intranasal Ketamine for Acute Pain Management in the Emergency Setting: A Systematic Review and Meta-Analysis

Erector spinae plane block vs non‐steroidal anti‐inflammatory drugs for severe renal colic pain: A pilot clinical feasibility study

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