Comparison of the analgesic effect of Ketamine and Midazolam with Apotel and Ketorolac in renal colic patients: a clinical trial

Abstract

Background: This study aimed to determine the effect of the Ketamine and Midazolam combination and compare it with the Apotel and Ketorolac combination in pain management of patients with renal colic in the emergency section. In this double-blind clinical trial study, 200 renal colic patients admitted to the ED with more than 8 NRS* (Numerical Rating Scale) of primary pain were divided into two groups by random blocking: one group received intravenous Ketamine (0.4 mg/kg), and intravenous Midazolam (at a dose of 0.016 mg/kg) and the other group received intravenous Ketorolac (30 mg) and intravenous Apotel (15 mg/kg). After that, we measured patients' pain at 1, 5, 10, 15, 30, and 45 min after the procedure. Results: 124 (62.0%) of 200 patients were men. Initial pain scores were 9(10-9) for Ketamine + Midazolam and 10(10-9) for Apotel + Ketorolac.Linear regression was performed to compare the two groups' adjusted pain scores, correcting for initial pain. The ultimate pain score increased by.392 units for each unit of starting pain. Group and time had significant effects (5.553, -.035, P=.001, respectively). Apotel + Ketorolac had a higher mean pain score than Ketamine + Midazolam at all post-intervention time intervals. During the trial, both groups' discomfort decreased dramatically. Conclusions: The combination of Ketamine and Midazolam was more effective than Apotel and Ketorolac in relieving the pain in renal colic. Therefore, if routine medications are contraindicated, a combination of Ketamine and Midazolam is recommended for pain control in patients with renal colic. Trial registration: This trial was registered in the Iranian Registry of Clinical Trials with IRCT registration number of IRCT20200422047163N1 (https://www.irct.ir/trial/47370) and registration date of 01/05/2020.