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Chen C, Zhang Z, Lin M, Wang Z, Liu H, Meng H, Wang J, Chen M, Xiang S, Qiu Y, Liu H. Acupressure versus parecoxib sodium in acute renal colic: A prospective cohort study. Front Med (Lausanne) 2023; 9:968433. [PMID: 36698807 PMCID: PMC9868725 DOI: 10.3389/fmed.2022.968433] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
Background Here provides a complementary treatment, acupressure at the Qiu acupoint, a novel acupoint, which potentially alleviates renal colic. Materials and methods 90 patients were included in this study. Acupressure-group patients (n = 46) were administered acupressure at the Qiu acupoint following a preset protocol. Parecoxib sodium-group patients (n = 44) were administered parecoxib sodium (40 mg) (via the direct intravenous route). The visual analog scale (VAS) was used to evaluate pain intensity at baseline and at 1, 5, 10, 20, 30, and 120 min after initiating the intervention. Linear mixed effects model was performed to detect the rate of decrease of VAS per time and their covariant effect on the efficacy of acupressure. Results No significant statistical differences in baseline data and VAS scores were observed. The acupressure group obtained lower VAS scores at the 1st, 5th, 10th, and 20th minute than the parecoxib sodium group after initiating the intervention (mean: 4.33 vs. 7.61, mean difference (MD): 3.29, 95% CI: 0.23, 2.84; mean: 2.65 vs. 7.61, MD: 4.96, 95% CI: 4.44, 5.49; mean: 1.63 vs. 6.59, MD: 4.96, 95% CI: 4.48, 5.44; mean: 1.26 vs. 3.64 MD: 2.38, 95% CI: 1.87, 2.88; P < 0.05). The markedly effective rate was similar between the two groups. The linear mixed effects model demonstrated that acupressure at the Qiu point was significantly faster than parecoxib sodium in decreasing VAS scores with an estimate of -2.05 (95% CI: -2.51, -1.59, p = 0.000), especially within 10 minutes with an estimate of 0.18 (95% CI: 0.12, 0.25, p = 0.000). Conclusion Acupressure at the Qiu acupoint is significantly faster than parecoxib sodium in decreasing VAS scores within 10 minutes. Clinical trial registration http://www.chictr.org.cn/, identifier 2100047168.
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Affiliation(s)
- Chiwei Chen
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China,The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhenpeng Zhang
- Shenzhen Hospital (Longgang), Beijing University of Traditional Chinese Medicine, Shenzhen, Guangdong, China
| | - Mandi Lin
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhigang Wang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Hao Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Hao Meng
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jun Wang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ming Chen
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Songtao Xiang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China,The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China,*Correspondence: Songtao Xiang,
| | - Yunqiao Qiu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China,Yunqiao Qiu,
| | - Hong Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China,Hong Liu,
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Corvino A, Magli E, Minale M, Autelitano A, Valente V, Pierantoni GM. Phloroglucinol-Derived Medications are Effective in Reducing Pain and Spasms of Urinary and Biliary Tracts: Results of Phase 3 Multicentre, Open-Label, Randomized, Comparative Studies of Clinical Effectiveness and Safety. Adv Ther 2023; 40:619-640. [PMID: 36443585 PMCID: PMC9898402 DOI: 10.1007/s12325-022-02347-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/04/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Pain and spasms of urinary and biliary tracts are conditions causing poor quality of life. Treatment with analgesic drugs such as non-steroidal anti-inflammatory drugs and modulators of the parasympathetic system are not always tolerated, and often additional therapeutic options are necessary. The present analysis aimed to evaluate the pharmacokinetics and effectiveness of oral and parenteral preparations based on phloroglucinol in reducing pain and spasms associated with renal or biliary colic in phase 3, multicentre, open-label, randomized, comparative studies on clinical effectiveness and safety. METHODS Pharmacokinetic and pharmacodynamic studies were carried out. Four phase 3 multicentre, open-label, randomized, comparative studies were conducted to evaluate the clinical effectiveness and safety in patients with pain and spasms of urinary or biliary tracts. Eligible patients randomly received either phloroglucinol orally or via intramuscular (IM)/intravenous (IV) administration and reference drug, dexketoprofen for urinary spasms and pain, the non-steroidal anti-inflammatory drug metamizole or scopolamine-based reference drug for biliary colic. The primary outcomes were symptoms and observed frequency of spasms, while the secondary outcome was the duration of improvement or the time between the drug administration and the recurrence of symptoms. Comparison of groups by quantitative characteristics was performed using the T-test for independent samples or the Mann-Whitney test. Intragroup comparisons were performed using the Wilcoxon test, or the T-test for linked samples. Qualitative signs were analysed using the Pearson's χ2 test and Fisher's exact test. RESULTS The pharmacokinetic studies showed that (i) most of the phloroglucinol (> 80% for IV and per os formulations) was eliminated in the first 6 h after dosing, (ii) the drug was eliminated in urine as unchanged phloroglucinol (1,3,5-trihydroxybenzene) in a small proportion (< 3% of the dose) and (iii) a considerable amount of the drug was detected after enzymatic deconjugation with β-glucoronidase/arylsulfatase from Helix pomatia. As for the pharmacokinetic study, a total of 364 patients were enrolled, divided in four studies: two designed to test the effectiveness of oral and IM/IV preparations in biliary colic and two in urinary colic. Baseline characteristics between groups were similar. Phloroglucinol oral or IV/IM showed an effectiveness comparable to the reference drug in reducing pain and spasms associated with both urinary and biliary colic. There was no difference between all groups by survival analysis. CONCLUSION Oral and parenteral preparations based on phloroglucinol are as effective in reducing pain and spasms associated with renal or biliary colic as current therapeutic options. Therefore, phloroglucinol may be considered as useful to treat pain and spasms associated with urinary and biliary colic.
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Affiliation(s)
- Angela Corvino
- grid.4691.a0000 0001 0790 385XDepartment of Pharmacy, University of Naples “Federico II”, Naples, Italy
| | - Elisa Magli
- grid.4691.a0000 0001 0790 385XDepartment of Pharmacy, University of Naples “Federico II”, Naples, Italy
| | | | | | - Valeria Valente
- grid.4691.a0000 0001 0790 385XDepartment of Molecular Medicine and Medical Biotechnology, University of Naples “Federico II”, Naples, Italy
| | - Giovanna Maria Pierantoni
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Naples, Italy.
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Mutlu H, Ertas K, Kokulu K, Sert ET, Diri MA, Gul M. An effective treatment option for pain caused by urolithiasis: A randomised-controlled trial of local active warming with heat-patch. Int J Clin Pract 2021; 75:e13969. [PMID: 33368937 DOI: 10.1111/ijcp.13969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/21/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND There is growing interest in physical medicine treatment options for renal colic. In this study, we aimed to determine whether or not heat-patch treatment with no drug was effective in relieving renal colic. METHODS For this purpose, patients who were diagnosed with renal colic in the emergency department were randomised to have either heat-patch or sham treatment. The Visual Analogue Scale (VAS) scores of renal colic, body temperature (Btemp), and sub-patch skin temperature (Stemp) values were measured at 0, 15, 30, 45, and 60 minutes. In addition, the salvage treatment needs of the groups were compared. RESULTS The average age of the study group was 30.5 ± 8.3 years and that of the sham group was 31.0 ± 8.2 years (P = .75). According to the baseline VAS score of the patients, 15, 30, 45, and 60 minutes VAS scores significantly decreased in the heat-patch group (P < .001). The Btemp values did not differ significantly between the heat-patch and sham groups. In addition, no statistically significant difference was found between the two groups in terms of Stemp values at 0 and 15 minutes (P = .39 and P = .10, respectively). However, there was a significant difference in the heat-patch group in terms of Stemp values at 30, 45, and 60 minutes compared with the sham group (P < .001). The salvage treatment rates for the heat-patch and sham groups were 11.5% and 31.4%, respectively (P = .01). CONCLUSION As non-pharmaceutical treatment, the heat-patch has been shown to be a possible candidate for pain relief in patients with urolithiasis. Further research should concentrate on multicentre and large scale randomised studies.
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Affiliation(s)
- Huseyin Mutlu
- Department of Emergency Medicine, Aksaray University School of Medicine, Aksaray, Turkey
| | - Kasim Ertas
- Department of Urology, Van Yüzüncü Yil University School of Medicine, Van, Turkey
| | - Kamil Kokulu
- Department of Emergency Medicine, Aksaray University School of Medicine, Aksaray, Turkey
| | - Ekrem Taha Sert
- Department of Emergency Medicine, Aksaray University School of Medicine, Aksaray, Turkey
| | - Mehmet Akif Diri
- Department of Urology, Aksaray University School of Medicine, Konya, Turkey
| | - Murat Gul
- Department of Urology, Selcuk University School of Medicine, Konya, Turkey
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Weltings S, Buddingh KT, van Diepen DC, Pelger RCM, Putter H, Rad M, Schout BMA, Roshani H. The BUSCOPAN study: a randomized-controlled non-inferiority trial of a continuous butylscopolamine infusion versus placebo in patients with a renal colic not responding to oral non-steroidal anti-inflammatory drugs. World J Urol 2020; 39:2747-2752. [PMID: 32949255 PMCID: PMC8332573 DOI: 10.1007/s00345-020-03460-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/10/2020] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To investigate whether placebo is non-inferior to continuous infusion of butylscopolamine in patients with renal colic. METHODS We conducted a placebo-controlled, multicenter, double-blind randomized clinical trial (RCT) including 128 patients with renal colic (confirmed by ultrasound or CT-scan). Patients were randomized to receive either continuous IV butylscopolamine 100 mg/24 h or placebo (saline). Primary outcome is the amount of opioid escape medication used, measured in doses administered. Secondary outcomes are pain measured on a Numeric Rating Scale (NRS), side effects, and time of drug administration. Non-inferiority was assessed using linear regression with robust standard errors, with non-inferiority limit set at 0.5 units of escape medication. RESULTS Median number of doses of escape medication was one in both groups. The number of extra doses in the placebo group compared with the butylscopolamine group was 0.05, with a 95% robust confidence interval (CI) of 0.38-0.47. Upper limit of the CI remained below the non-inferiority limit of 0.5 (p = 0.04). No differences in secondary endpoints were seen between the groups. CONCLUSION Placebo is non-inferior to continuous IV butylscopolamine for pain relief in patients with renal colic. Based on this study and previous evidence, there is no role for continuous butylscopolamine IV in the treatment of renal colic. Trial NL7819.
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Affiliation(s)
- S Weltings
- Haga Teaching Hospital, The Hague, The Netherlands.
| | - K T Buddingh
- Haga Teaching Hospital, The Hague, The Netherlands
| | | | | | | | - M Rad
- Haga Teaching Hospital, The Hague, The Netherlands
| | - B M A Schout
- Alrijne Health Group, Leiderdorp, The Netherlands
| | - H Roshani
- Haga Teaching Hospital, The Hague, The Netherlands
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Zolfaghari Sadrabad A, Azimi Abarghouei S, Farahmand Rad R, Salimi Y. Intravenous magnesium sulfate vs. morphine sulfate in relieving renal colic: A randomized clinical trial. Am J Emerg Med 2020; 46:188-192. [PMID: 33071088 DOI: 10.1016/j.ajem.2020.07.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 07/03/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Renal colic emerging from renal stone is virtually the most severe pain which is experienced. Intravenous infusion of morphine sulfate is known as a usual treatment for the disease. This study was designed to compare the efficacy of magnesium sulfate vs morphine sulfate in renal colic relief as for analgesic effect as well as lack of morphine sulfate side effects when using magnesium sulfate. METHODS We conducted a double-blind randomized clinical trial in renal colic patients who had referred to the emergency department of Shahid Sadoughi Hospital in Yazd, Iran. A total of 80 eligible patients were selected and randomly assigned into two groups; patients in the case group received 50 mg/kg intravenous magnesium sulfate, and those in the control group 0.1 mg/kg intravenous morphine. The primary outcome was the pain score measured on a numerical rating scale at 0, 10 and 20 minutes after infusion. Data were analyzed using SPSS16. RESULTS The two groups were similar in terms of demographic features and pain intensity at the time of referral (P <.0001). Ten minutes after drug administration, the pain mean score in the morphine group leveled at 4.88, and in the magnesium group 5.70, which proved to be greater in the morphine group (P- = 0.06). However, the pain mean score turned out to be 3.65 in the morphine group and 3.20 in the magnesium group thus significantly indifferent (P = .48). CONCLUSIONS In this study, we concluded that administration of intravenous 50 mg/kg magnesium sulfate could be as effective as morphine in reducing renal colic without any further complications.
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Affiliation(s)
- Akram Zolfaghari Sadrabad
- Clinical Research Development Center, Imam Reza Hospital, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Soheila Azimi Abarghouei
- Emergency Medicine Department, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Reza Farahmand Rad
- Clinical Research Development Center, Imam Reza Hospital, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Salimi
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; Department of Epidemiology, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Rezaei B, Salimi R, Kalantari A, Astaraki P. Comparison of efficacy nebulized fentanyl with intravenous ketorolac for renal colic in patients over 12 years old. Am J Emerg Med 2020; 44:358-361. [PMID: 32345561 DOI: 10.1016/j.ajem.2020.04.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Acute renal colic is one of the common causes of referral to the hospitals. The aim of this study is to compare the efficacy of nebulized fentanyl with that of intravenous ketorolac in renal colic patients. MATERIALS & METHODS This double-blinded clinical study included 186 patients with acute renal colic who were referred to the emergency department of Besat Hospital, Iran. PATIENT SELECTION After selecting patients, according to study inclusion and exclusion criteria, they were divided into 2 groups of 93 using random block allocation method. The patients in the groups were treated with either nebulized fentanyl or intravenous ketorolac. The severity of pain was measured using the Numeric Pain Rating Scale (NPRS) of pain. The severity of pain at different times and demographic data were recorded. RESULTS One hundred and thirty four males and 52 females with a mean age of 42.95 ± 13.13 years were included in the study. The two groups were matched in terms of age, sex, and the severity of the pain before the treatment. Fifteen minutes following the treatment, the severity of pain was decreased in the ketorolac group but did not change in the nebulized fentanyl group. Thirty minutes after the administration of the drug, the severity of pain in the nebulized fentanyl group decreased. At any time, the severity of pain in the ketorolac group was lower than that of the nebulized fentanyl group. CONCLUSION Intravenous ketorolac had better analgesic effects in renal colic patients compared with nebulized fentanyl. Further studies that include complications and combinational therapy are required.
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Affiliation(s)
- Bareza Rezaei
- Clinical Research Development Center of Taleghani, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rasoul Salimi
- Department of Emergency Medicine, School of Medicine, Besat Hospital, Hamedan University of Medical Sciences, Hamedan, Iran.
| | - Alireza Kalantari
- Department of Emergency Medicine, Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Peyman Astaraki
- Faculty of Medicine, Department of Internal Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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Sasmaz Mİ, Kirpat V. The relationship between the severity of pain and stone size, hydronephrosis and laboratory parameters in renal colic attack. Am J Emerg Med 2019; 37:2107-2110. [DOI: 10.1016/j.ajem.2019.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/02/2019] [Accepted: 06/04/2019] [Indexed: 01/05/2023] Open
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Shams-vahdati S, Robaei N, Habibollah P, Jafari-rouhi A, Mohammadi S, Piri R. Paracetamol vs. Intravenous Morphine Plus Diclofenac in Renal Colic Pain: A Randomized Clinical Trial. Nephrourol Mon 2018; 10. [DOI: 10.5812/numonthly.77193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kaya FB, Cevik A, Acar N, Kaya S, Zeytin A, Can C, Metintas S. Clinical Efficacy of Metoclopramide to Treat Pain and Nausea in Renal Colic Patients: A Prospective Randomised, Double-Blind, Controlled Trial. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791502200203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction This study aimed to evaluate the clinical efficacy of intravenous metoclopramide for the relief of pain and nausea among the emergency department patients with renal colic. Methods Patients were randomised into three groups: tenoxicam (20 mg); tenoxicam (10 mg) plus metoclopramide (10 mg); and metoclopramide (10 mg). Changes in pain and nausea were examined at the 10th, 20th and 30th minute after treatment. The development of side effects would be recorded. After the 30th minute, the need for additional pain and nausea relief was evaluated. Results Totally 80 patients were enrolled in each group. There was significant mean pain score difference as measured by visual analog scale (VAS) from 0 minute to 10th, 20th and 30th minute post-treatment for all treatment groups (p<0.001). There was no significant difference in mean VAS decrease from 0 minute to the 30th minute: tenoxicam group: 36 mm [95% confidence interval (CI) 28-43 mm] vs. tenoxicam plus metoclopramide: 45 mm (95% CI 38-52 mm) vs. metoclopramide group: 37 mm (95% CI 30-45 mm) (p=0.163). Similarly, no significant differences in mean nausea scores between the three groups were demonstrated at the 10th, 20th and 30th minute after treatment (p=0.236, 0.330 and 0.652 respectively). After the 30th minute, 43 (53%) patients needed additional pain relieving agent in the tenoxicam group compared to 27 (33%) patients in the tenoxicam-metoclopramide group and 33 (41%) patients in the metoclopramide group (p=0.030). No significant adverse drug reaction events were encountered. Conclusion Metoclopramide is as effective as tenoxicam to treat pain and nausea for patients with renal colic in the emergency department. (Hong Kong j.emerg.med.2015;22:93-99)
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Affiliation(s)
- F Baloglu Kaya
- Eskisehir Osmangazi University Medical Center Department of Urology, Meselik, 26480, Eskisehir, Turkey
| | - Aa Cevik
- Eskisehir Osmangazi University Medical Center Department of Urology, Meselik, 26480, Eskisehir, Turkey
| | - N Acar
- Eskisehir Osmangazi University Medical Center Department of Urology, Meselik, 26480, Eskisehir, Turkey
| | - S Kaya
- Eskisehir Osmangazi University Medical Center Department of Urology, Meselik, 26480, Eskisehir, Turkey
| | - At Zeytin
- Eskisehir Osmangazi University Medical Center Department of Urology, Meselik, 26480, Eskisehir, Turkey
| | - C Can
- Eskisehir Osmangazi University Medical Center Department of Urology, Meselik, 26480, Eskisehir, Turkey
| | - S Metintas
- Eskisehir Osmangazi University Medical Center Department of Urology, Meselik, 26480, Eskisehir, Turkey
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Ziapor B, Motamed H, Maleki Verki M, Norani H. Comparison of Effect of Morphine-Chlorpheniramine Combined Versus Morphine Alone in Alleviating Acute Renal Colic Pain: A Randomized Clinical Trail. Jundishapur J Nat Pharm Prod 2017; 12. [DOI: 10.5812/jjnpp.15585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abbasi S, Bidi N, Mahshidfar B, Hafezimoghadam P, Rezai M, Mofidi M, Farsi D. Can low-dose of ketamine reduce the need for morphine in renal colic? A double-blind randomized clinical trial. Am J Emerg Med 2018; 36:376-9. [PMID: 28821365 DOI: 10.1016/j.ajem.2017.08.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 08/08/2017] [Accepted: 08/12/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The combination of morphine with low doses of ketamine (MK) has been utilized in the Emergency Department (ED) compared with morphine and placebo (MP) for the treatment of acute pain in few studies. The purpose of this study was to compare the effect of MP with MK for the treatment of severe pain with renal colic of patients who had been referred to the ED. METHODS This study is a double blind randomized clinical trial on patients with severe renal colic pain who were referred to the ED. Patients were enrolled with pain severity of at least 6 of the 10 visual analogue scales (VAS). Patients were divided into two groups: Morphine 0.1mg/kg and placebo (MP group) and morphine 0.1mg/kg and ketamine 0.15mg/kg (MK group). Pain of patients was studied in 10, 30, 60, 90, and 120min after injection. RESULTS Totally, 106 patients were enrolled in study groups. Assessment of the average pain during 120min at 10 and 30min after the start in the drug, MK group was significantly lower than the MP group (p=0.019 and p=0.003 respectively). CONCLUSION Given that combinations of morphine with low doses of ketamine in patients with renal colic pain causes more pain and morphine consumption reduction then this combination is suggested as an alternative treatment that could be utilized in patients with renal colic.
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Maldonado-avila M, Del Rosario-santiago M, Rosas-nava JE, Manzanilla-garcia HA, Rios-davila VM, Rodriguez-nava P, Vela-mollinedo RA, Garduño-arteaga ML. Treatment of reno-ureteral colic by twelfth intercostal nerve block with lidocaine versus intramuscular diclofenac. Int Urol Nephrol 2017; 49:413-7. [DOI: 10.1007/s11255-016-1479-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/06/2016] [Indexed: 12/12/2022]
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Irmak Sapmaz H, Uysal M, Taş U, Esen M, Barut M, Somuk BT, Alatlı T, Ayan S. The Effect of Lavender Oil in Patients with Renal Colic: A Prospective Controlled Study Using Objective and Subjective Outcome Measurements. J Altern Complement Med 2015. [PMID: 26222759 DOI: 10.1089/acm.2015.0112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To assess the usability of lavender oil as an adjuvant in the medical treatment of pain due to renal stones. METHODS One hundred patients age 19-64 years diagnosed with renal colic were included in the study. Group 1 (n=50) received standard medical therapy (diclofenac sodium, 75 mg intramuscularly); group 2 (n=50) received aromatherapy (lavender oil) in addition to the standard medical treatment. In both groups, the severity of the pain was graded between 0 (no pain) and 10 (severe pain) by using the visual analogue scale (VAS). RESULTS The VAS values at the beginning and at 10 and 30 minutes in group 1 were 7.70±1.61, 5.02±2.20, and 2.89±1.96, respectively; in group 2, the values were 7.83±2.02, 4.42±2.46, and 2.20±1.74, respectively. The VAS values for the male patients in group 1 at the beginning and at 10 and 30 minutes were 7.61±1.47, 4.80±2.00, and 2.67±1.74; in the female patients, the values were 7.81±1.80, 5.40±2.41, and 3.72±1.94. For the male patients in group 2, the VAS values at the beginning and at 10 and 30 minutes were 8.25±2.01, 4.93±2.72, and 2.96±1.90, respectively; for the female patients, the values were 7.52±1.94, 4.15±1.95, and 1.21±0.91, respectively. Results are presented as mean±SD. Although there was no significant difference between the VAS values at the beginning and at 10 minutes in both groups, the VAS values at 30 minutes in the group receiving aromatherapy plus conventional treatment were statistically significantly low. CONCLUSION These findings suggest that the use of aromatherapy, which is a nonpharmacologic treatment method, as an adjuvant to conventional treatment methods will help decrease pain, particularly in female patients.
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Affiliation(s)
- Hilal Irmak Sapmaz
- 1 Faculty of Medicine, Department of Anatomy, Gaziosmanpasa University , Tokat, Turkey
| | - Murat Uysal
- 1 Faculty of Medicine, Department of Anatomy, Gaziosmanpasa University , Tokat, Turkey
| | - Ufuk Taş
- 1 Faculty of Medicine, Department of Anatomy, Gaziosmanpasa University , Tokat, Turkey
| | - Mehmet Esen
- 2 Faculty of Medicine, Department of Emergency Medicine, Gaziosmanpasa University , Tokat, Turkey
| | - Mustafa Barut
- 3 Clinic of Internal Medicine, Tokat State Hospital , Tokat, Turkey
| | - Battal Tahsin Somuk
- 4 Faculty of Medicine, Department of Ear, Nose and Throat Diseases, Gaziosmanpasa University , Tokat, Turkey
| | - Tufan Alatlı
- 2 Faculty of Medicine, Department of Emergency Medicine, Gaziosmanpasa University , Tokat, Turkey
| | - Safiye Ayan
- 5 Faculty of Medicine, Department of Biochemistry, Gaziosmanpasa University , Tokat, Turkey
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Atescelik M, Yilmaz M, Gurger M, Yildiz M. The effect of meteorological parameters on the number of renal colic patients. Urolithiasis 2015; 43:331-7. [DOI: 10.1007/s00240-015-0779-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/21/2015] [Indexed: 11/28/2022]
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Ioannidis S, Kampantais S, Ioannidis A, Gkagkalidis K, Vakalopoulos I, Toutziaris C, Patsialas C, Laskaridis L, Dimopoulos P, Dimitriadis G. Dermal scarification versus intramuscular diclofenac sodium injection for the treatment of renal colic: a prospective randomized clinical trial. Urolithiasis 2014; 42:527-32. [PMID: 25074713 DOI: 10.1007/s00240-014-0690-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 07/15/2014] [Indexed: 10/25/2022]
Abstract
The aim of the study is to determine whether dermal scarification is equally effective for treating acute renal colic compared to diclofenac sodium intramuscular therapy. A prospective, randomized controlled study was conducted with methodologic rigor based on CONSORT criteria. A total of 291 patients, aged ≥ 18 years, suffering from acute renal colic were included in this trial and randomly assigned in two groups. Patients in the first group (A) received endodermal injection (dermal scarification) of 1 ml normal saline at the area of intensity of pain. The second group (B) received 75 mg diclofenac sodium by intramuscular injection. The success of each method defined the primary end point. Pain intensity before and after treatment was assessed using a visual analog scale. The time onset and the duration of analgesia were also recorded. There was no significant difference between the two groups regarding hematuria (p = 0.158), stone identification at KUB (p = 0.751) and mean pain intensity (p = 0.609) before treatment initiation. The method was successful in 75.5 % of patients in group A and 74.3 % of patients in group B (p = 0.812). Mean pain reduction was comparable, 5.65 ± 3.05 in group A and 5.34 ± 2.99 in group B (p = 0.379), with dermal scarification eliciting its effect considerably faster, whereas the duration of analgesia was longer in the diclofenac group (p < 0.05). In conclusion, dermal scarification could constitute an alternative method for treating renal colic as it is equally effective compared to the standard treatment of diclofenac sodium.
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Affiliation(s)
- Stavros Ioannidis
- 1st Urologic Department, Aristotle University of Thessaloniki, 41 Ethnikis Aminis Str, 54643, Thessaloniki, Greece
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Papadopoulos G, Bourdoumis A, Kachrilas S, Bach C, Buchholz N, Masood J. Hyoscine N-butylbromide (Buscopan®) in the treatment of acute ureteral colic: what is the evidence? Urol Int 2014; 92:253-7. [PMID: 24576895 DOI: 10.1159/000358015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 12/14/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the evidence for the use of hyoscine N-butylbromide (HBB) in the treatment of acute renal colic. METHODS A literature search was performed using the keywords 'hyoscine N-butylbromide', 'ureteral colic', 'spasmolytic', 'anticholinergic' and 'analgesia'. The articles were given the appropriate level of evidence according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence guidelines. RESULTS The analgesic effect of HBB as monotherapy is inferior to that of opioids and/or non-steroidal anti-inflammatory drugs (NSAIDs). It does provide an analgesic and antispasmodic effect, but not as long-lasting as NSAIDs. HBB does not serve as an adjunct to opioids. Furthermore, it does not facilitate passage of ureteral stones and has no effect on expulsion rate. CONCLUSIONS HBB is often used where urinary tract smooth muscle spasm is thought to be part of the pathophysiological process. According to the evidence, administration of HBB follows non-peer-reviewed protocols which are based on empiric recommendations. Its role is still unclear, as it appears to have no advantage when used as monotherapy over established forms of analgesia. There appears to be a time-dependent relation to pain reduction following parenteral administration, but this needs to be confirmed by more prospective randomized cohorts.
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Golzari SEJ, Soleimanpour H, Rahmani F, Zamani Mehr N, Safari S, Heshmat Y, Ebrahimi Bakhtavar H. Therapeutic approaches for renal colic in the emergency department: a review article. Anesth Pain Med 2014; 4:e16222. [PMID: 24701420 PMCID: PMC3961032 DOI: 10.5812/aapm.16222] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 12/08/2013] [Accepted: 12/16/2013] [Indexed: 12/21/2022] Open
Abstract
Context: Renal colic is frequently described as the worst pain ever experienced, and management of this intense pain is necessary. The object of our review was to discuss different approaches of pain control for patients with acute renal colic in the emergency department. Evidence Acquisition: Studies that discussed the treatment of renal colic pain were included in this review. We collected articles from reputable internet databases. Results: Our study showed that some new treatment approaches, such as the use of lidocaine or nerve blocks, can be used to control the severe and persistent pain of renal colic. Conclusions: Some new approaches are discussed and their impact on renal colic pain control was compared with traditional therapies. The effectiveness of the new approaches in this review is similar or even better than in traditional treatments.
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Affiliation(s)
- Samad EJ Golzari
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Soleimanpour
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Corresponding author: Hassan Soleimanpour, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Tel: +989141164134, Fax: +984113352078, E-mail:
| | - Farzad Rahmani
- Emergency Medicine Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nahid Zamani Mehr
- Students Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeid Safari
- Anesthesiology and Critical Care Department, Iran University of Medical Sciences, Tehran, Iran
| | - Yaghoub Heshmat
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Ayan M, Tas U, Sogut E, Suren M, Gurbuzler L, Koyuncu F. Investigating the effect of aromatherapy in patients with renal colic. J Altern Complement Med 2012; 19:329-33. [PMID: 23072267 DOI: 10.1089/acm.2011.0941] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
AIM The aim of the present study was to investigate the usefulness of rose essential oil as a supplementary and adjunctive therapy for the relief of renal colic, specifically because rose essential oil is soothing and can act as a muscle relaxant. MATERIALS Eighty patients who were diagnosed with renal colic in the emergency room were included in the study, with ages ranging from 19 to 64 years. Half of the patients (n=40) were treated with conventional therapy (diclofenac sodium, 75 mg intramuscularly) plus placebo (physiological serum, 0.9% NaCl), while the other half (n=40) were given aromatherapy (rose essential oil) in addition to conventional therapy. In each patient, the severity of pain was evaluated using the Visual Analog Scale (VAS) (0 [no pain] to 10 [very severe pain]). FINDINGS The VAS values prior to the start of therapy, and 10 and 30 minutes after therapy were 8.18 ± 1.36, 5.60 ± 2.02, and 3.75 ± 2.08 for the conventional therapy plus placebo group, while for the conventional therapy plus aromatherapy group, the VAS values were 8.63 ± 1.03, 4.25 ± 1.72, and 1.08 ± 1.07, respectively. There was no statistically significant difference between the starting VAS values of the two groups, but the VAS values 10 or 30 minutes after the initiation of therapy were statistically lower in the group that received conventional therapy plus aromatherapy. CONCLUSION This study demonstrated that rose essential oil therapy in addition to conventional therapy effectively reduces renal colic pain.
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Affiliation(s)
- Murat Ayan
- Department of Emergency Medicine, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey.
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Ayan M, Sogut E, Tas U, Erdemir F, Sahin M, Suren M, Kaya Z, Demirturk F. Pain levels associated with renal colic and primary dysmenorrhea: a prospective controlled study with objective and subjective outcomes. Arch Gynecol Obstet 2012; 286:403-9. [DOI: 10.1007/s00404-012-2316-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Accepted: 03/22/2012] [Indexed: 01/20/2023]
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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 2011; 24:144-50. [PMID: 22487663 DOI: 10.1111/j.1742-6723.2011.01502.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the effect of adding butylscopolammonium bromide (BB) to morphine and ketorolac in the treatment of acute renal colic in the ED. METHODS A prospective, double-blind, randomized controlled trial of i.v. triple therapy (morphine, ketorolac and BB) versus double therapy (morphine and ketorolac) in adult ED patients with a clinical diagnosis of acute renal colic and a pain rating greater than five on a 10 cm visual analogue scale (VAS). VAS was recorded at time 0, 20 and 40 min. Patients received rescue morphine at 20 or 40 min according to the protocol if needed. We compared pain reduction and the need for rescue analgesia at 4 min between two groups. RESULTS Eighty-nine patients were randomized over a 13 month period. A total of 46 (51.7%) patients received BB in addition to morphine and ketorolac. The mean difference in change in pain score in the triple therapy group and double therapy group was 7.1 cm (95% CI 6.4-7.8) and 5.9 cm (95% CI 5.1-6.7), respectively (P= 0.024). Rescue morphine was required by 7/46 (15.2% [95% CI 4.4-20.6]) patients in the triple therapy group and 14/43 (32.6% [95% CI 18.0-47.1]) in the double therapy group (OR 0.37 [95% CI 0.133-1.038]). CONCLUSIONS Although the addition of BB to morphine and ketorolac appeared to show a statistically significant reduction in pain compared with morphine and ketorolac alone, a reduction of 1.2 cm on VAS is unlikely to be clinically significant.
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Affiliation(s)
- Sung Wook Song
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Sungnam-si, Seoul, Korea
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Steinberg PL, Nangia AK, Curtis K. A standardized pain management protocol improves timeliness of analgesia among emergency department patients with renal colic. Qual Manag Health Care 2011; 20:30-6. [PMID: 21192205 DOI: 10.1097/QMH.0b013e31820429d9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Kidney stones are a common, and extremely painful, cause of emergency department (ED) visits. Pain management is a critical component of high-quality patient care. A pilot study at our institution found that only 69% of ED patients with renal colic had evidence of clinically significant analgesia. OBJECTIVE In response to these findings, we evaluated the impact of a formalized pain management protocol on timeliness of analgesia among ED patients with renal colic. SUBJECTS AND METHODS Using a before and after study design, adult ED patients with renal colic were eligible. In the prospective arm, patients were treated with ketorolac, 30 mg intravenous, and morphine, 0.05-0.1 mg/kg intravenous, according to a standardized protocol. Results were compared with a retrospective chart review of eligible patients treated during a similar preprotocol period. RESULTS Implementation of the protocol resulted in a significant reduction in time to effective analgesia (72 ± 63 vs 37 ± 42 minutes, P = .003). The protocol did not result in any increase in adverse effects. CONCLUSION Implementation of a standardized pain management protocol among ED patients with renal colic resulted in a marked improvement in quality of care as evidenced by a 49% reduction in time to effective analgesia.
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Grissa MH, Claessens YE, Bouida W, Boubaker H, Boudhib L, Kerkeni W, Boukef R, Nouira S. Paracetamol vs piroxicam to relieve pain in renal colic. Results of a randomized controlled trial. Am J Emerg Med 2011; 29:203-6. [DOI: 10.1016/j.ajem.2009.09.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 08/27/2009] [Accepted: 09/17/2009] [Indexed: 11/17/2022] Open
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Boubaker H, Boukef R, Claessens Y, Bouida W, Grissa MH, Beltaief K, Trimech MN, Kerkeni W, Boudhib L, Nouira S. Phloroglucinol as an adjuvant analgesic to treat renal colic. Am J Emerg Med 2010; 28:720-3. [DOI: 10.1016/j.ajem.2009.04.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 04/20/2009] [Accepted: 04/20/2009] [Indexed: 11/17/2022] Open
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Roshani A, Falahatkar S, Khosropanah I, Roshan ZA, Zarkami T, Palizkar M, Emadi SA, Akbarpour M, Khaki N. Assessment of Clinical Efficacy of Intranasal Desmopressin Spray and Diclofenac Sodium Suppository in Treatment of Renal Colic Versus Diclofenac Sodium Alone. Urology 2010; 75:540-2. [DOI: 10.1016/j.urology.2008.05.053] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 05/14/2008] [Accepted: 05/17/2008] [Indexed: 11/20/2022]
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Eken C, Durmaz D, Erol B. Successful treatment of a persistent renal colic with trigger point injection. Am J Emerg Med 2009; 27:252.e3-4. [DOI: 10.1016/j.ajem.2008.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Accepted: 06/04/2008] [Indexed: 10/20/2022] Open
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Yilmaz E, Batislam E, Deniz T, Yuvanc E. Histamine 1 Receptor Antagonist in Symptomatic Treatment of Renal Colic Accompanied by Nausea: Two Birds With One Stone? Urology 2009; 73:32-6. [DOI: 10.1016/j.urology.2008.08.494] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 07/24/2008] [Accepted: 08/25/2008] [Indexed: 11/21/2022]
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Yencilek F, Aktas C, Goktas C, Yilmaz C, Yilmaz U, Sarica K. Role of papaverine hydrochloride administration in patients with intractable renal colic: randomized prospective trial. Urology 2008; 72:987-90. [PMID: 18789511 DOI: 10.1016/j.urology.2008.07.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2008] [Revised: 05/26/2008] [Accepted: 07/04/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the therapeutic effect of papaverine hydrochloride in the treatment of patients with renal colic pain unresponsive to conventional treatment. METHODS From March 2007 to January 2008, a total of 561 patients with severe renal colic pain due to a ureteral stone were treated with conventional agents (hyoscine-N-butylbromide and diclofenac sodium) in the emergency and urology departments. Of these 561 patients, 110, with no response to the treatment and persistent severe pain, were randomized into 3 groups for additional treatment. The patients in group 1 (n = 37) received intravenous hyoscine-N-butylbromide, those in group 2 (n = 37) received papaverine hydrochloride, and those in group 3 (n = 36) received pethidine. Before and after treatment, all patients completed a visual analog scale (VAS) questionnaire, with a scale of 0 (no pain) to 10 (maximal complaint), to measure their subjective pain. The mean VAS score of each group was compared with that of the other groups. RESULTS The pretreatment mean VAS scores of all 3 groups were not significantly different statistically from each other (4.02 +/- 1.20, 4.36 +/- 1.97, and 4.27 +/- 1.50; P > .05). However, after treatment, the mean VAS scores of the patients treated with papaverine (0.93 +/- 0.29) and pethidine (0.81 +/- 0.38) were significantly different from those of the hycosine group (3.67 +/- 2.21; P < .001). However, the mean VAS scores of groups 2 and 3 were comparable (P = .67). Unlike opioids, no papaverine-related severe side effects were observed. CONCLUSIONS Our results indicate that papaverine hydrochloride can used in an effective manner in the management of renal colic pain in patients unresponsive to commonly used conventional agents.
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Affiliation(s)
- Faruk Yencilek
- Department of Urology, Yeditepe University Hospital, Istanbul, Turkey.
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&NA;. Pharmacological management of uncomplicated renal colic in elderly patients requires control of acute pain and perhaps medical expulsion therapy. Drugs & Therapy Perspectives 2008. [DOI: 10.2165/00042310-200824070-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Snir N, Moskovitz B, Nativ O, Margel D, Sandovski U, Sulkes J, Livne PM, Lifshitz DA. 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] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2007] [Indexed: 11/16/2022]
Affiliation(s)
- Nimrod Snir
- Institute of Urology, Rabin Medical Center, Beilinson Hospital, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Moskovitz
- Department of Urology, Bnei-Zion Medical Center, Haifa, Israel
| | - Ofer Nativ
- Department of Urology, Bnei-Zion Medical Center, Haifa, Israel
| | - David Margel
- Institute of Urology, Rabin Medical Center, Beilinson Hospital, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Sandovski
- Department of Emergency Medicine, Rabin Medical Center, Beilinson Hospital, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacqueline Sulkes
- Epidemiology Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pinchas M. Livne
- Institute of Urology, Rabin Medical Center, Beilinson Hospital, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David A. Lifshitz
- Institute of Urology, Rabin Medical Center, Beilinson Hospital, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Affiliation(s)
- C. Charles Wen
- Division of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tawnya L. Cary Coyle
- Division of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Travis J. Jerde
- Division of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Stephen Y. Nakada
- Division of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Abstract
Renal colic affects up to 12% of the population. Initial management of most patients is expectant. Acute symptom management of renal colic is best accomplished with a combination of parenteral opioids and NSAIDs. The elderly patient with a kidney stone should be screened for contraindications to NSAID therapy, such as renal failure or previous peptic ulcer disease. Use of parenteral opioids is often necessary during the acute setting, and downward-adjusted doses and monitoring are necessary to prevent associated confusion and respiratory depression. Novel therapy with desmopressin may also be effective for symptom control at the initial presentation, without the adverse effects of opioids or NSAIDs. However, use of desmopressin in the elderly must be undertaken cautiously, given the potential adverse effects of this agent. Many small, distal ureteral stones are treated initially with watchful waiting for the first 2-4 weeks after presentation. The patient should have effective, non-parenteral analgesics for use at home. Included in these agents are oral or suppository NSAIDs and oral opioids. Medical expulsion therapy with alpha-adrenoceptor antagonists or calcium channel antagonists is efficacious. alpha-Adrenoceptor antagonists such as the alpha(1A/)(1)(D)-selective tamsulosin are well tolerated in the elderly and increase the rate of spontaneous stone passage by approximately 50% for small distal stones. These agents also appear to decrease the severity of renal colic. Corticosteroids and calcium channel antagonists are also effective but their use in the elderly is not recommended as first-line therapy.
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Affiliation(s)
- Blayne K Welk
- Department of Urologic Sciences, University of British Columbia, Providence Healthcare, Vancouver, British Columbia, Canada
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Gupta B, Nellore V, Mittal S. Drotaverine hydrochloride versus hyoscine-N-butylbromide in augmentation of labor. Int J Gynaecol Obstet 2007; 100:244-7. [PMID: 18031745 DOI: 10.1016/j.ijgo.2007.08.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2007] [Revised: 08/26/2007] [Accepted: 08/30/2007] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To study and compare the efficacy and side effects of drotaverine hydrochloride and hyoscine-N-butylbromide in the augmentation of labor. METHODS A prospective randomized trial of 150 women in active labor included 50 women given drotaverine (group 1), 50 women given hyoscine-N-butylbromide (group 2), and 50 women given no medication (group 3). Duration of labor, rate of cervical dilation, mode of delivery, side effects, and neonatal outcome were compared among the groups. RESULTS The mean duration of the active phase of labor was 4.48+/-2.26 h, 3.9+/-2.42 h, and 3.6+/-2.07 h in groups 1, 2, and 3, respectively. The mean rate of cervical dilation was 2.6 cm/h, 2.4 cm/h, and 2.5 cm/h, respectively. The differences were not statistically significant. There was no difference in the duration of the second and third stages of labor. No adverse maternal or fetal outcomes were noted. CONCLUSION Drotaverine hydrochloride and hyoscine-N-butylbromide do not have a role in augmentation of labor.
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Affiliation(s)
- Bindiya Gupta
- Department of Obstetrics and Gynecology, All India Institute of Medical Science, Ansari nagar, New Delhi, India.
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Sánchez-Carpena J, Domínguez-Hervella F, García I, Gene E, Bugarín R, Martín A, Tomás-Vecina S, García D, Serrano JA, Roman A, Mariné M, Mosteiro ML. Comparison of intravenous dexketoprofen and dipyrone in acute renal colic. Eur J Clin Pharmacol 2007; 63:751-60. [PMID: 17571256 DOI: 10.1007/s00228-007-0322-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Accepted: 05/02/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to assess the efficacy and safety of a single intravenous (i.v.) bolus of dexketoprofen trometamol compared with an i.v. infusion of dipyrone in patients with moderate to severe pain due to renal colic. METHODS A total of 308 patients with renal colic and visual analog scale (VAS) score >/=40 mm participated in a multicenter, randomized, double blind, double-dummy, parallel, and active-controlled study and were randomized to dexketoprofen 25 mg (n = 101), dexketoprofen 50 mg (n = 104), and dipyrone 2 g (n = 103). RESULTS Mean [+/- standard deviation (SD)] total pain relief (TOTPAR) scores were similar in the dexketoprofen 50 mg (15.3 +/- 8.6) and dipyrone (15.5 +/- 8.6) and slighly higher than in dexketoprofen 25 mg (13.5 +/- 8.6), although significant differences were not achieved. In the same way, patients in the dexketoprofen 50 mg and dipyrone groups showed higher scores in the sum of pain intensity differences (SPID) and the sum of analogue pain intensity differences (SAPID) than patients in the dexketoprofen 25 mg group, reaching statistical significance in comparison with dexketoprofen 25 mg and dipyrone for SPID and SAPID (p < 0.05). The time-effect course for pain intensity differences and pain relief showed significantly higher values for both doses of dexketoprofen during the first 30 min after drug administration (p < 0.05). Dexketoprofen 50 mg and dipyrone groups had 66% and 70%, respectively, of patients with at least 50% of maximum obtainable TOTPAR in comparison with 56% in the dexketoprofen 25 mg group. The study medications were well tolerated. CONCLUSIONS Dexketoprofen 50 mg administered as a single i.v. bolus was effective for the relief of moderate to severe pain in patients with renal colic, with a good safety profile and efficacy similar to i.v. dipyrone 2 g. Dexketoprofen produced analgesia that was faster in onset.
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Affiliation(s)
- Nicole L Miller
- Methodist Hospital Institute for Kidney Stone Disease, Indiana University School of Medicine, and International Kidney Stone Institute, Indianapolis, IN 46202, USA
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Abstract
Nephrolithiasis treatment has become easier and less invasive with the development of extracorporeal shockwave lithotripsy (SWL) and endourologic techniques. However, medical therapy represents a well-established and complementary approach that can improve the efficacy of SWL and endourology. During recent decades, pharmacologic intervention has become more effective in stone disease: drugs can control the pain of renal colic, interfere at various levels in lithogenesis, and contribute to the expulsion of stones. It is well known that lithogenesis is a multifactorial process influenced by environmental-nutritional factors (low urinary volume, diet rich in animal protein, etc) and metabolic alterations; i.e., hypercalciuria, hyperuricosuria, and deficiency of stone-inhibiting factors (citrate, magnesium, glycosaminoglycans [GAGs]). Specific drugs such as citrate, allopurinol, and thiazide represent highly effective treatments for the promoting factors. Furthermore, recent findings suggest an interesting role for a phytotherapeutic agent, Phillantus niruri, and its inhibitory action on calcium oxalate crystallization related to the higher incorporation of GAGs into the calculi. Another step forward in medical management of stone disease is expulsive therapy. Many studies have proven the efficacy of medical expulsive therapy with nifedipine and alpha-blockers: their specific action on ureteral smooth muscle in association with anti-edema drugs accounts for their efficacy in expelling ureteral stones. In this paper, we provide an update on the medical treatment of stone disease, focusing our attention on what is known and what is new in renal colic and litholithic and expulsive medical therapy.
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Affiliation(s)
- S Micali
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
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Esquena S, Millán Rodríguez F, Sánchez-Martín FM, Rousaud Barón F, Marchant F, Villavicencio Mavrich H. Cólico renal: Revisión de la literatura y evidencia científica. Actas Urol Esp 2006; 30:268-80. [PMID: 16749583 DOI: 10.1016/s0210-4806(06)73439-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In recent years diagnosis and treatment of acute renal colic have changed thanks to the introduction of new radiological procedures that allow with high reliability to establish obstructive cause and a better treatment. In the other hand, there are multiple clinical studies that show the most effective treatments for acute crisis. The aim of this revision is to update the diagnostic and therapeutic aspects of renal colic which were modified recently, and allowed to break some classic concepts without scientific evidence.
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Affiliation(s)
- S Esquena
- Servicio de Urología, Fundació Puigvert, Barcelona.
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Abstract
PURPOSE We determined whether the addition of hyoscine butylbromide (Buscopan) reduces the amount of opioid analgesia required and the need for ongoing opioid analgesia in acute renal colic. MATERIALS AND METHODS Patients with a clinical diagnosis of acute renal colic were prospectively randomized to receive Buscopan or placebo in addition to morphine and intravenous fluids, with or without indomethacin. Observations and pain scores were recorded 15 every minutes during the first hour then hourly thereafter. Morphine was administered in 2.5 mg increments until pain relief was achieved. Recordings were ceased at 4 hours or on discharge from the emergency department, whichever occurred first. The diagnosis of renal colic was confirmed by computerized tomography. The dose of morphine (mg/kg) and the proportion of patients who required further morphine were compared between the 2 groups. RESULTS Of the 192 patients randomized, data were available for 178 on an intent to treat basis. A total of 85 patients received Buscopan while 93 received placebo in addition to standard therapy. Patients in the Buscopan group required a median of 0.12 mg/kg of morphine while those in the placebo group received a median of 0.11 mg/kg, and this difference was not significant (p =0.4). There was also no significant difference in the proportion of patients who required additional morphine, 33% in the Buscopan group and 38% in the placebo group (p =0.5). Subgroup analysis of the 138 patients with a confirmed stone also showed no difference between the groups. CONCLUSIONS There is no evidence that Buscopan reduces opioid requirements or the need for ongoing opioid analgesia in acute renal colic.
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Affiliation(s)
- Anna Holdgate
- Department of Emergency Medicine, St. George Hospital, Sydney, Australia.
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