The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Low-dose intravenous ketamine versus intravenous ketorolac in pain control in patients with acute renal colic in an emergency setting: a double-blind randomized clinical trial

  • Sotoodehnia, Mehran (Prehospital Emergency Research Center and Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences) ;
  • Farmahini-Farahani, Mozhgan (Prehospital Emergency Research Center and Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences) ;
  • Safaie, Arash (Prehospital Emergency Research Center and Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences) ;
  • Rasooli, Fatemeh (Prehospital Emergency Research Center and Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences) ;
  • Baratloo, Alireza (Prehospital Emergency Research Center and Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences)
  • Received : 2018.12.18
  • Accepted : 2019.01.23
  • Published : 2019.04.01
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Abstract

Background: This study was conducted to compare the effectiveness of low-dose ketamine versus ketorolac in pain control in patients with acute renal colic presenting to the emergency department (ED). Methods: This is a double-blind randomized clinical trial. The initial pain severity was assessed using the numerical rating scale (NRS). Then, ketamine or ketorolac was administered intravenously at a dose of 0.6 mg/kg and 30 mg respectively. The pain severity and adverse drug reactions were recorded 5, 15, 30, 60, and 120 min thereafter. Results: The data of 62 subjects in the ketamine group and 64 patients in the ketorolac group were analyzed. The mean age of the patients was $34.2{\pm}9.9$ and $37.9{\pm}10.6\;years$ in the ketamine and ketorolac group, respectively. There was no significant difference in the mean NRS scores at each time point, except for the 5 min, between the two groups. Despite a marked decrease in pain severity in the ketamine group from drug administration at the 5 min, a slight increase in pain was observed from the 5 min to the 15 min. The rate of adverse drug reactions, including dizziness (P = 0.001), agitation (P = 0.002), increased systolic blood pressure (> 140 mmHg), and diastolic blood pressure (> 90 mmHg) was higher in the ketamine group. Conclusions: Low dose ketamine is as effective as ketorolac in pain management in patients with renal colic presenting to the ED. However, it is associated with a higher rate of adverse drug reactions.

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References

  1. Teichman JM. Clinical practice: acute renal colic from ureteral calculus. N Engl J Med 2004; 350: 684-93. https://doi.org/10.1056/NEJMcp030813
  2. Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol 2010; 12: e86-96.
  3. Brown J. Diagnostic and treatment patterns for renal colic in US emergency departments. Int Urol Nephrol 2006; 38: 87-92. https://doi.org/10.1007/s11255-005-3622-6
  4. Zabihi N, Teichman JM. Dealing with the pain of renal colic. Lancet 2001; 358: 437-8. https://doi.org/10.1016/S0140-6736(01)05668-9
  5. Engeler DS, Schmid S, Schmid HP. The ideal analgesic treatment for acute renal colic: theory and practice. Scand J Urol Nephrol 2008; 42: 137-42. https://doi.org/10.1080/00365590701673716
  6. Bounes V, Valle B, Concina F, Lauque D, Ducasse JL, Edlow JA. Treatment of acute renal colic in Us and French EDs: simulated cases and real cases in acute pain management. Am J Emerg Med 2016; 34: 1955-8. https://doi.org/10.1016/j.ajem.2016.06.107
  7. Shin MT, Juho YC, Meng E, Sun GH, Cha TL, Wu ST, et al. Pain severity in renal colic: a retrospective evaluation of initial visits in patients at a medical center. Int Surg J 2016; 3: 480-3.
  8. Janati M, Kariman H, Memary E, Davarinezhad-Moghadam E, Arhami-Dolatabadi A. Educational intervention effect on pain management quality in emergency department; a clinical audit. Adv J Emerg Med 2018; 2: e16.
  9. Miller NL, Lingeman JE. Management of kidney stones. BMJ 2007; 334: 468-72. https://doi.org/10.1136/bmj.39113.480185.80
  10. Knoedler JJ, Lieske JC. Non-steroidal anti-inflammatory drugs for renal colic. Lancet 2016; 387: 1971-2. https://doi.org/10.1016/S0140-6736(16)00745-5
  11. Bultitude M, Rees J. Management of renal colic. BMJ 2012; 345: e5499. https://doi.org/10.1136/bmj.e5499
  12. Benyamin R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N, et al. Opioid complications and side effects. Pain Physician 2008; 11(2 Suppl): S105-20.
  13. Baratloo A, Amiri M, Forouzanfar MM, Hasani S, Fouda S, Negida A. Efficacy measurement of ketorolac in reducing the severity of headache. J Emerg Pract Trauma 2016; 2: 21-4. https://doi.org/10.15171/jept.2015.18
  14. Alimohammadi H, Baratloo A, Abdalvand A, Rouhipour A, Safari S. Effects of pain relief on arterial blood o2 saturation. Trauma Mon 2014; 19: e14034.
  15. Edwards JM, Sloan EP, Eder S, Chan S. Renal colic patient pain management in the emergency department. Ann Emerg Med 2004; 44(4 Suppl): S58.
  16. Abdolrazaghnejad A, Banaie M, Tavakoli N, Safdari M, Rajabpour-Sanati A. Pain management in the emergency department: a review article on options and methods. Adv J Emerg Med 2018; 2: e45.
  17. Tramer MR, Williams JE, Carroll D, Wiffen PJ, Moore RA, McQuay HJ. Comparing analgesic efficacy of non-steroidal anti-inflammatory drugs given by different routes in acute and chronic pain: a qualitative systematic review. Acta Anaesthesiol Scand 1998; 42: 71-9. https://doi.org/10.1111/j.1399-6576.1998.tb05083.x
  18. Manthey DE, Nicks BA. Urologic stone disease. In: Tintinalli's emergency medicine: a comprehensive study guide. 8th ed. Edited by Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM. New York, McGraw-Hill. 2016, pp 609-13.
  19. Jackson J, Farhi J, Wheeler K, Rueb G, Thom C, Schenkman N. Retrospective review of acute renal colic management in the emergency department and review of guidelines. Urol Pract 2018; 5: 113-9. https://doi.org/10.1016/j.urpr.2017.02.007
  20. 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.
  21. Holdgate A, Pollock T. Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic. BMJ 2004; 328: 1401. https://doi.org/10.1136/bmj.38119.581991.55
  22. Svenson JE, Abernathy MK. Ketamine for prehospital use: new look at an old drug. Am J Emerg Med 2007; 25:977-80. https://doi.org/10.1016/j.ajem.2007.02.040
  23. Morgan CJ, Curran HV; Independent Scientific Committee on Drugs. Ketamine use: a review. Addiction 2012; 107: 27-38. https://doi.org/10.1111/j.1360-0443.2011.03576.x
  24. Persson J. Ketamine in pain management. CNS Neurosci Ther 2013; 19: 396-402. https://doi.org/10.1111/cns.12111
  25. Mohammadshahi A, Abdolrazaghnejad A, Nikzamir H, Safaie A. Intranasal ketamine administration for narcotic dose decrement in patients suffering from acute limb trauma in emergency department: a double-blind randomized placebocontrolled trial. Adv J Emerg Med 2018; 2: e30.
  26. Pasero C, McCaffery M. Pain control: ketamine: low doses may provide relief for some painful conditions. Am J Nurs 2005; 105: 60-4. https://doi.org/10.1097/00000446-200504000-00028
  27. Weisz K, Bajaj L, Deakyne SJ, Brou L, Brent A, Wathen J, et al. Adverse events during a randomized trial of ketamine versus co-administration of ketamine and propofol for procedural sedation in a pediatric emergency department. J Emerg Med 2017; 53: 1-9. https://doi.org/10.1016/j.jemermed.2017.03.024
  28. Treston G, Bell A, Cardwell R, Fincher G, Chand D, Cashion G. What is the nature of the emergence phenomenon when using intravenous or intramuscular ketamine for paediatric procedural sedation? Emerg Med Australas 2009; 21: 315-22. https://doi.org/10.1111/j.1742-6723.2009.01203.x
  29. Huge V, Lauchart M, Magerl W, Schelling G, Beyer A, Thieme D, et al. Effects of low-dose intranasal (S)-ketamine in patients with neuropathic pain. Eur J Pain 2010; 14: 387-94. https://doi.org/10.1016/j.ejpain.2009.08.002
  30. Bilgen S, Koner O, Ture H, Menda F, Ficicioglu C, Aykac B. Effect of three different doses of ketamine prior to general anaesthesia on postoperative pain following Caesarean delivery: a prospective randomized study. Minerva Anestesiol 2012; 78: 442-9.
  31. Loeser JD, Melzack R. Pain: an overview. Lancet 1999; 353: 1607-9. https://doi.org/10.1016/S0140-6736(99)01311-2
  32. Sadove MS, Shulman M, Hatano S, Fevold N. Analgesic effects of ketamine administered in subdissociative doses. Anesth Analg 1971; 50: 452-7.
  33. Visser E, Schug SA. The role of ketamine in pain management. Biomed Pharmacother 2006; 60: 341-8. https://doi.org/10.1016/j.biopha.2006.06.021
  34. Galinski M, Dolveck F, Combes X, Limoges V, Smail N, Pommier V, et al. Management of severe acute pain in emergency settings: ketamine reduces morphine consumption. Am J Emerg Med 2007; 25: 385-90. https://doi.org/10.1016/j.ajem.2006.11.016
  35. Bespalov AY, Zvartau EE, Beardsley PM. Opioid-NMDA receptor interactions may clarify conditioned (associative) components of opioid analgesic tolerance. Neurosci Biobehav Rev 2001; 25: 343-53. https://doi.org/10.1016/S0149-7634(01)00018-5
  36. Farnia MR, Jalali A, Vahidi E, Momeni M, Seyedhosseini J, Saeedi M. Comparison of intranasal ketamine versus IV morphine in reducing pain in patients with renal colic. Am J Emerg Med 2017; 35: 434-7. https://doi.org/10.1016/j.ajem.2016.11.043
  37. Vosoughin M, Mohammadi S, Dabbagh A. Intravenous ketamine compared with diclofenac suppository in suppressing acute postoperative pain in women undergoing gynecologic laparoscopy. J Anesth 2012; 26: 732-7. https://doi.org/10.1007/s00540-012-1399-1
  38. Assouline B, Tramer MR, Kreienbuhl L, Elia N. Benefit and harm of adding ketamine to an opioid in a patient-controlled analgesia device for the control of postoperative pain: systematic review and meta-analyses of randomized controlled trials with trial sequential analyses. Pain 2016; 157: 2854-64. https://doi.org/10.1097/j.pain.0000000000000705
  39. Holinstat M. Normal platelet function. Cancer Metastasis Rev 2017; 36: 195-8. https://doi.org/10.1007/s10555-017-9677-x
  40. Tawfic QA. A review of the use of ketamine in pain management. J Opioid Manag 2013; 9: 379-88. https://doi.org/10.5055/jom.2013.0180
  41. Andolfatto G, Willman E, Joo D, Miller P, Wong WB, Koehn M, et al. Intranasal ketamine for analgesia in the emergency department: a prospective observational series. Acad Emerg Med 2013; 20: 1050-4. https://doi.org/10.1111/acem.12229
  42. Wedmore IS, Johnson T, Czarnik J, Hendrix S. Pain management in the wilderness and operational setting. Emerg Med Clin North Am 2005; 23: 585-601, xi-xii. https://doi.org/10.1016/j.emc.2004.12.017
  43. Allen CA, Ivester JR Jr. Ketamine for pain management-side effects & potential adverse events. Pain Manag Nurs 2017; 18: 372-7. https://doi.org/10.1016/j.pmn.2017.05.006
  44. Ghate G, Clark E, Vaillancourt C. Systematic review of the use of low-dose ketamine for analgesia in the emergency department. CJEM 2018; 20: 36-45. https://doi.org/10.1017/cem.2017.48

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