Document Type: Original Article

Authors

1 Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran

2 Department of Biostatistics, School of Allied Medical Sciences, Students Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

4 Department of Medical Informatics, School of Allied Medical Sciences, Students Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran

5 Clinical Research Development Unit, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran

Abstract

Objective: Renal colic is a common cause of emergency room visits. Due to the spontaneous passage of more than 90% of kidney stones, treatment in the emergency department (ED) is limited to pain control. Analgesics currently used are selected based on physician experiences and various theories from different sources. The aim of this study was to compare the common drugs (pethidine and diclofenac) used for renal colic in Iran. 
Methods: In this single-blinded randomized clinical trial, 90 patients with renal colic who referred to the ED of Imam Reza hospital in Kermanshah were randomly assigned to each of 3 treatments including pethidine suppository (50 mg, iv), diclofenac suppository (50 mg), and a combination of pethidine and diclofenac suppository. In this regard, the response to treatment and duration of hospitalization were compared. 
Results: The best medicine to relieve pain intensity in patients under 25 years was diclofenac suppository. In patients in the age range of 25-45 years, pethidine and diclofenac were the best choice. Conversely, in patients older than 45 years, pethidine was the best treatment. We could also observe a decrease in the length of hospitalization in patients who received pethidine.  
Conclusion: It can be concluded that morphine is more appropriate to control pain and reduce the length of hospitalization in patients with renal colic.   Clinical Trial Registration: irct.ir Identifier: IRCT20101214538  

Keywords

Main Subjects

1. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA. Campbell-Walsh Urology. 10th ed. Saunders; 2011.

2. Salameh S, Hiller N, Antopolsky M, Ghanem F, Abramovitz Y, Stalnikowics R. Diclofenac versus tramadol in the treatment of renal colic: a prospec-tive, randomized trial. The Open Emergency Medicine Journal 2011; 4: 9-13.

3. Kolasani BP, Juturu J. Intramuscular ketorolac versus diclofenac in acute renal colic: a comparative study of efficacy and safety. Indian Journal of Basic & Applied Medical Research 2013; 2(8): 923-31.

4. Ziemba JB, Matlaga BR. Guideline of guidelines: kidney stones. BJU Int 2015; 116(2): 184-9.

5. Safarinejad MR. Adult urolithiasis in a population-based study in Iran: prevalence, incidence, and associated risk factors. Urol Res 2007; 35(2): 73-82.

6. Safdar B, Degutis LC, Landry K, Vedere SR, Moscovitz HC, D’Onofrio G. Intravenous morphine plus ketorolac is superior to either drug alone for treatment of acute renal colic. Ann Emerg Med 2006; 48(2): 173-81.

7. Kallidonis P, Liourdi D, Liatsikos E. Medical treatment for renal colic and stone expulsion. European Urology Supplements 2011; 10(5): 415-22.

8. Rezakhaniha B, Safari Nezhad MR, Markazi Moghaddam N, Valimanesh HA, Abd Elahian M. The comparison of the efficay of commom pain management in acute renal colic. Annals of Military and Health Sciences Research 2004; 2(3): 381-5.

9. Alimohammadi H, Baratloo A, Abdalvand A, Rouhipour A, Safari S. Effects of pain relief on arterial blood o2 saturation. Trauma Mon 2014; 19(1): e14034.

10. Flannigan GM, Clifford RP, Carver RA, Yule AG, Madden NP, Towler JM. lndomethacin—an Alternative to Pethidine in Ureteric Colic. Br J Urol 1983; 55(1): 6-9.

11. Holdgate A, Pollock T. Nonsteroidal anti‐inflammatory drugs (NSAIDs) versus opioids for acute renal colic. Cochrane Database Syst Rev 2004; (1): CD004137.

12. Larkin GL, Peacock WF, Pearl SM, Blair GA, D’Amico F. Efficacy of ketorolac tromethamine versus meperidine in the ED treatment of acute renal colic. Am J Emerg Med 1999; 17(1): 6-10.

13. Ghuman J, Vadera R. Ketorolac and morphine for analgesia in acute renal colic: Is this combination more effective than monotherapy? CJEM 2008; 10(1): 66-8.

14. Engeler D, Schmid S, Schmid HP. The ideal analgesic treatment for acute renal colic--theory and practice. Scand J Urol Nephrol 2008; 42(2): 137-42.

15. Tintinalli JE, Stapczynski JS. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. New York: McGraw-Hill; 2011.

16. O’Connor A, Schug SA, Cardwell H. A comparison of the efficacy and safety of morphine and pethidine as analgesia for suspected renal colic in the emergency setting. J Accid Emerg Med 2000; 17(4): 261-4.