Document Type : Original Article(s)
Authors
- Javad Mozafari 1
- Ali Khavanin 1
- Ali Delirrooyfard 1
- Mohammadreza Pirouzi 1
- Naeimehossadat Asmarian 2
1 Department of Emergency Medicine, Ahvaz Jundishapour University of Medical Sciences, Ahvaz, Iran
2 Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
Background: Acute renal colic has been challenging and has brought many concerns for physicians and patients for centuries. This study aimed to evaluate the analgesic effect and safety of a combination of papaverine and ketorolac against ketorolac and placebo in treating acute renal colic.
Methods: This randomized clinical trial was performed in patients with renal colic from May 2018 to May 2020 in Ahvaz, Iran. Patients with colic pain due to sand or kidney stones underwent clinical examination. The pain intensified based on the visual analog scale (VAS) and the patients’ need for rescue analgesia are considered as primary outcomes at various times after treatment. Patients were equally divided into two groups: A (ketorolac plus papaverine) and B (ketorolac plus placebo) by block balanced randomization method. Student t test, the Chi square, and ANOVA tests were used for statistical analyses, which were performed by SPSS 19.0. P<0.05 was considered significant.
Results: A significant difference was observed in 280 patients (140 patients in each group) in pain intensity between both groups at 45 and 60 min. VAS scores in groups A and B were 5.08±1.23 and 5.56±1.11 in 45 min and 3.35±1.47 and 3.92±1.31 in 60 min (P=0.001, P=0.002), respectively. In subgroup analysis, the VAS score significantly decreased after taking the drug for middle and proximal ureteral stones at 45 and 60 min (P<0.001). Rescue analgesics were required in 7 (5%) and 21 (15%) patients in groups A and B, respectively (P=0.005). Side effects were similar in the two groups.
Conclusion: In this study, ketorolac, along with papaverine, was effective in acute renal colic control, and combination therapy with ketorolac and papaverine was associated with reduced use of other rescue analgesics.
Trial registration number: IRCT20190217042738N1.
Keywords
- Portis AJ, Sundaram CP. Diagnosis and initial management of kidney stones. American family physician. 2001;63:1329-39.
- Diri A, Diri B. Management of staghorn renal stones. Ren Fail. 2018;40:357-62. doi: 10.1080/0886022X.2018.1459306. PubMed PMID: 29658394; PubMed Central PMCID: PMCPMC6014528.
- Holdgate A, Oh CM. Is there a role for antimuscarinics in renal colic? A randomized controlled trial. J Urol. 2005;174:572-5. doi: 10.1097/01.ju.0000165337.37317.4c. PubMed PMID: 16006900.
- Phillips E, Hinck B, Pedro R, Makhlouf A, Kriedberg C, Hendlin K, et al. Celecoxib in the management of acute renal colic: a randomized controlled clinical trial. Urology. 2009;74:994-9. doi: 10.1016/j.urology.2009.04.063. PubMed PMID: 19589565.
- Dellabella M, Milanese G, Muzzonigro G. Randomized trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculi. J Urol. 2005;174:167-72. doi: 10.1097/01.ju.0000161600.54732.86. PubMed PMID: 15947613.
- Onen A. Grading of Hydronephrosis: An Ongoing Challenge. Front Pediatr. 2020;8:458. doi: 10.3389/fped.2020.00458. PubMed PMID: 32984198; PubMed Central PMCID: PMCPMC7481370.
- Yamashita S, Kohjimoto Y, Iguchi T, Nishizawa S, Kikkawa K, Hara I. Ureteral wall volume at ureteral stone site is a critical predictor for shock wave lithotripsy outcomes: comparison with ureteral wall thickness and area. Urolithiasis. 2020;48:361-8. doi: 10.1007/s00240-019-01154-w. PubMed PMID: 31444520.
- He M, Lin X, Lei M, Xu X, He Z. Risk Factors of Urinary Tract Infection After Ureteral Stenting in Patients with Renal Colic During Pregnancy. J Endourol. 2021;35:91-6. doi: 10.1089/end.2020.0618. PubMed PMID: 32680438.
- Eidinejad L, Bahreini M, Ahmadi A, Yazdchi M, Thiruganasambandamoorthy V, Mirfazaelian H. Comparison of intravenous ketorolac at three doses for treating renal colic in the emergency department: A noninferiority randomized controlled trial. Acad Emerg Med. 2021;28:768-75. doi: 10.1111/acem.14202. PubMed PMID: 33370510.
- Afshar K, Jafari S, Marks AJ, Eftekhari A, MacNeily AE. Nonsteroidal anti-inflammatory drugs (NSAIDs) and non-opioids for acute renal colic. Cochrane Database Syst Rev. 2015;2015:CD006027. doi: 10.1002/14651858.CD006027.pub2. PubMed PMID: 26120804; PubMed Central PMCID: PMCPMC10981792.
- Asgari SA, Asli MM, Madani AH, Maghsoudi PA, Ghanaei MM, Shakiba M, et al. Treatment of loin pain suspected to be renal colic with papaverine hydrochloride: a prospective double-blind randomised study. BJU Int. 2012;110:449-52. doi: 10.1111/j.1464-410X.2011.10793.x. PubMed PMID: 22348304.
- Snir N, Moskovitz B, Nativ O, Margel D, Sandovski U, Sulkes J, et al. Papaverine hydrochloride for the treatment of renal colic: an old drug revisited. A prospective, randomized study. J Urol. 2008;179:1411-4. doi: 10.1016/j.juro.2007.11.053. PubMed PMID: 18289563.
- Davenport K, Timoney AG, Keeley FX. Conventional and alternative methods for providing analgesia in renal colic. BJU Int. 2005;95:297-300. doi: 10.1111/j.1464-410X.2005.05286.x. PubMed PMID: 15679781.
- Umezawa S, Higurashi T, Uchiyama S, Sakai E, Ohkubo H, Endo H, et al. Visual distraction alone for the improvement of colonoscopy-related pain and satisfaction. World J Gastroenterol. 2015;21:4707-14. doi: 10.3748/wjg.v21.i15.4707. PubMed PMID: 25914482; PubMed Central PMCID: PMCPMC4402320.
- Song SW, Kim K, Rhee JE, Lee JH, Seo GJ, Park HM. Butylscopolammonium bromide does not provide additional analgesia when combined with morphine and ketorolac for acute renal colic. Emerg Med Australas. 2012;24:144-50. doi: 10.1111/j.1742-6723.2011.01502.x. PubMed PMID: 22487663.
- Bucci FA, Jr., Michalek B, Fluet AT. Comparison of the frequency of use of a pupil expansion device with and without an intracameral phenylephrine and ketorolac injection 1%/0.3% at the time of routine cataract surgery. Clin Ophthalmol. 2017;11:1039-43. doi: 10.2147/OPTH.S132552. PubMed PMID: 28615924; PubMed Central PMCID: PMCPMC5460648.
- Arhami Dolatabadi A, Memary E, Kariman H, Nasiri Gigloo K, Baratloo A. Intranasal Desmopressin Compared with Intravenous Ketorolac for Pain Management of Patients with Renal Colic Referring to the Emergency Department: A Randomized Clinical Trial. Anesth Pain Med. 2017;7:e43595. doi: 10.5812/aapm.43595. PubMed PMID: 28824859; PubMed Central PMCID: PMCPMC5556593.
- Ye Z, Yang H, Li H, Zhang X, Deng Y, Zeng G, et al. A multicentre, prospective, randomized trial: comparative efficacy of tamsulosin and nifedipine in medical expulsive therapy for distal ureteric stones with renal colic. BJU Int. 2011;108:276-9. doi: 10.1111/j.1464-410X.2010.09801.x. PubMed PMID: 21083640.
- Hosseininejad SM, Amini Ahidashti H, Bozorgi F, Goli Khatir I, Montazar SH, Jahanian F, et al. Efficacy and Safety of Combination Therapy with Ketorolac and Morphine in Patient with Acute Renal Colic; A Triple-Blind Randomized Controlled Clinical Trial. Bull Emerg Trauma. 2017;5:165-70. PubMed PMID: 28795060; PubMed Central PMCID: PMCPMC5547203.
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