Therapeutic Approaches for Renal Colic in the Emergency Department: A Review Article

Golzari, Samad Ej; Soleimanpour, Hassan; Rahmani, Farzad; Mehr, Nahid Zamani; Safari, Saeid; Heshmat, Yaghoub; Bakhtavar, Hanieh Ebrahimi

doi:10.5812/aapm.16222

Cited by 55 publications

(65 citation statements)

References 49 publications

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“…15 Üriner akımın böbrek taşına bağlı tıkanmasıyla ortaya çıkan, üriner sistem duvarındaki basınç artışı, düz kas spazmları, inflamasyon, ödem ve peristaltizm artışı ile renal kolik ağrısı meydana gelir. 16 Akut flank ağrılarının nedeni her zaman böbrek taşı değildir, aort diseksiyonu gibi ölümcül farklı nedenlerde göz önünde tutulmalıdır. 8 Benzer şekilde, hastamızda ani ortaya çıkan sağ flank ağrısı, renal kolik olarak değerlendirilmiş ve hasta taburcu olduktan yaklaşık iki saat sonar, hastanemiz acil servisine kardiyopulmoner arrest olarak getirilmiştir.…”

Section: Introductionunclassified

A Fatal Diagnosis in Emergency Department: Renal Colic

Küçük¹

2015

Sakarya Med J

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Aort diseksiyonu, nadir görülen, bazı farklı hastalıkları taklit edebilen ölümcül bir hastalıktır. Daha çok erkeklerde, 50-70 yaş aralığında görülür. Hipertansiyon, etyolojisinde en önemli faktördür. Çoğunlukla yırtıcı vasıfta, ani ve şiddetli ağrı tariflenir. Distal diseksiyonlarda, malperfüzyona sonucu böbrek iskemileri, buna bağlı bel ve flank ağrısı görülebilir. Bu ağrıya benzer karakterdeki renal kolik, ciddi, aralıklı flank ağrısı olarak tanımlanır. Aort diseksiyonu, renal kolik ayırıcı tanısında yer alan ölümcül bir hastalıktır. Acil hekimleri, özellikle ileri yaştaki hastalara renal kolik tanısı koyarken dikkatli olmalı, altta yatan aort diseksiyonu gibi ölümcül bir hastalığı göz ardı etmemelidirler.

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Section: Introductionunclassified

A Fatal Diagnosis in Emergency Department: Renal Colic

Küçük¹

2015

Sakarya Med J

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“…Renal failure is caused by the decreased production of prostaglandins, which aid in afferent glomerular arteriole vasodilation. NSAIDs contribute to arteriolar vasoconstriction, leading to decreased renal perfusion pressure and decreased glomerular filtration rates [51]. This is worsened by dehydration.…”

Section: Nonsteroidal Anti-inflammatory Drugsmentioning

confidence: 99%

“…Each NSAID has variability in the risk of gastrointestinal injury it poses. This is due to the selectivity of COX-1 inhibition, so that the relative risk of for ibuprofen is 2.6, while the relative risk for ketorolac is 14.5 [51,53].…”

Section: Nonsteroidal Anti-inflammatory Drugsmentioning

confidence: 99%

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Acute Pain Management in the Emergency Department

Samcam¹,

Papa²

2016

Pain Management

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The most common presenting complaint to the emergency department (emergency room) is pain. Unfortunately, pain is still undertreated in this setting. Literature has shown that treatment of pain not only improves patient satisfaction but also improves mood, decreases length of hospital stay, and decreases mortality. Various pharmacological options are available for treating acute pain, ranging from oral, intravenous, and intramuscular medications; topical agents; and peripheral nerve blocks. Objectively assessing and documenting a patient's pain is the key to determining treatment. The approach to a patient with acute pain requires an experienced clinician who is aware of the pharmacology of analgesics and anesthetics, contraindications, precautions, side effects, administration methods, and monitoring requirements.This chapter briefly covers the pathophysiology of acute pain and the different treatment modalities available to the emergency physician.

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“…For the treatment of severe pain is useful to combine non-steroidal anti-inflammatory drugs (NSAIDs) and opioids. [3][4][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.…”

Section: Introductionmentioning

confidence: 99%

Intranasal ketorolac and opioid in treatment of acute renal colic

Etteri¹,

Maj

Maino³

et al. 2018

Emerg Care J

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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...

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Therapeutic Approaches for Renal Colic in the Emergency Department: A Review Article

Cited by 55 publications

References 49 publications

A Fatal Diagnosis in Emergency Department: Renal Colic

A Fatal Diagnosis in Emergency Department: Renal Colic

Acute Pain Management in the Emergency Department

Intranasal ketorolac and opioid in treatment of acute renal colic

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