Intranasal ketorolac and opioid in treatment of acute renal colic

Abstract

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. IntroductionFive to fifteen percent of the population is found to be affected by urinary stones during their lifetime and the 50% of this population shows recurrent calcolosis within 5-10 years from the first symptons. 1 The classic presentation of a renal stone is acute, colicky flank pain radiating to the groin. In the Emergency Department (ED), 2 initial management of renal colic is based on rational and fast diagnostic process, rapid and effective pain control.Ketorolac and morphine administered with intravenous (IV) route are the drugs of choice to treat pain in acute renal colic. For the treatment of severe pain is useful to combine non-steroidal anti-inflammatory drugs (NSAIDs) and opioids.3-5 However, the insertion of a IV cannula is not always easy in the agitated patient suffering for renal colic. The intranasal route for the administration of NSAIDs and opiates such as ketorolac and fentanyl, is a new and valid alternative method to provide safe and effective analgesia in patients with trauma and burns. Materials and Methods Study designThis study was a prospectic non-blinded trial. The Institutional review board of our center approved the study, and all patients gave written informed consent. Study setting and populationThe patients were adults aged >18, presenting in ED with classical clinical symptoms of renal colic (sudden monolateral flank pain with inguinal irradiation) with a 10-cm visual analogue scale (VAS) greater than or equa...

Comparison of rectal suppository and intramuscular morphine for management of patients with renal colic referred to the emergency department: A randomized double-blinded controlled trial

“…26,27 Morphine administered with IV route is a drug of choice to manage pain in acute renal colic. 28 Nevertheless, the other routes of morphine administration, e.g., oral, IM and rectal are available to relieve pain in different conditions. 29,30 Studies have proven that IM administration of opioids has been considered to be safer than IV.…”

Diagnostic role of ultrasonography and X-RAY combined versus intravenous urography in evaluation of renal colic.

“…Intranasal route of analgesics in spray form has also been proved equally effective as intravenous route by a study conducted on 82 cases in Italy. 4 About 2-5% Asian and 20% population of Saudi Arabia develop renal stone once in life time. 5 When clinical diagnosis is not clear radiological investigations should be done to make the diagnosis.…”