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Comparison of intramuscular injection of ketorolac and conventional treatment in the field of cost-effectiveness, length of stay and pain relief in patients admitted to the emergency department with renal colic

  • Rosana Hexam ,
  • Mahdi Rezai ,
  • Delaram Delbari ,
  • Yasaman Sadat Keshmiri ,
  • Hamed Aghdam ,
  • Darab Zohri ,

Abstract

Background: Pain resulting from the stone passage is one of the most severe and intractable pain experiences. The aim of our study is evaluating the effect of intra-muscular ketorolac on pain reduction; reduce the length of stay and cost of patients with renal colic.

Methods: This was a randomized clinical trial study which held in an academic emergency department (ED). Based on defined criteria, 222 patients with renal colic were randomized in two groups: half of them received a single intramuscular injection of 30 mg ketorolac, and other 111 patients got conventional treatment (hydration, morphine sulfate). Demographic characteristics, pain score after 30 minutes, the length of stay in ED, complications as well as hospital costs were recorded for both groups.

Result: The baseline characteristics and pain score were similar in the two groups (p>0.05). Ketorolac was significantly (p<0.001) more effective than conventional treatment in reducing pain score. Those treated with ketorolac left the ED significantly earlier than those treated with conventional treatment (65.54; 95%CI, 59.7-71.5 vs. 193.1; 95%CI, 172.8-215.2 minutes, p<0.001). Drug adverse effects (nausea, dizziness, and drowsiness) and cost of ketorolac group were significantly lower than the control group (43310 Tomans (110$) (95% CI, 42590-44030) vs. 150410 Tomans (350$) (95% CI, 240100-70940). (p<0.001).

Conclusion: This study showed that intramuscular ketorolac as a single agent for renal colic is cost-effective and promotes earlier discharge of renal colic patients from the ED.

References

  1. Curhan GC. Epidemiology of stone disease. Urol Clin North Am. 2007; 34(3):287-93.
  2. Leslie S. Why do kidney stone hurt so much? Family Urology. 2000; 5(1):27.
  3. Joel M.H. Acute renal colic from ureteral calculus. N Engl J Med. 2004; 350:684-693.
  4. 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(4):1411–4.
  5. 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(5):987–90.
  6. Barzegarnezhad A, Firouzian A, Emadi SA, Mousanejad N, Bakhshali R. The Effects of Local Administration of Aminophylline on Transureteral Lithotripsy. Adv Uro. 2012; 2012:727843.
  7. Presti JC, Kane JChJ, Shinohara K, Carroll PR. Neoplasms of the prostate gland. In: Tanagho EA, McAninch JW. Smith's. general urology. Philadelphia: Mc Graw Hill; 2008:348-55.
  8. Portis AJ, Sundaram CP. Diagnosis and initial management of kidney stones. Am Fam Physician. 2001; 63(7): 1329-38.
  9. Choe H, Lee YK, Lee YT, Choe H, Ko SH, Joo CU, et al. Papaverine blocks hKv1 channel current and human atrial ultrarapid delayed rectifier K+ currents. J Pharmacol Exp Ther. 2003; 304(2):706–12.
  10. 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(3):449–52.
  11. Holdgate A, Pollock T. Systematic review of the relative efficacy of non-steroidal inflammatory drugs and opioids in the treatment of acute renal colic. BMJ. 2004; 328(7453):1401.
  12. Michaed C. Acute postoperative pain. In: Patrick DW. Ronald M. Textbook of pain: From Churchill Livingstone. Edinburgh: UK. 1994:337-57.
  13. John JB. Postoperative pain. In: John JB, Chapman CR, Wilbert EF, management of pain: from Lea Febiger. Philadelphia: USA. 1999:461-81.
  14. Oosterlinck W, Philp NH, Charig C, Gillies G, Hetherington JW, Lloyd J. A double-blind single dose comparison of intramuscular ketorolac tromethamine and pethidine in the treatment of renal colic. J Clin Pharmacol. 1990; 30(4):336-41.
  15. Cordell WH, Wright SW, Wolfson AB, Timerding BL, Maneatis TJ, Lewis RH, Bynum L, Nelson DR. Comparison of intravenous ketorolac, meperidine and both (balanced analgesia) for renal colic. Ann Emerg Med. 1996; 28(2):151-8.
  16. 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.
  17. Sandhu DPS, Iacovou JW, Fletcher MS, Kaisary AV, Philip NH, Arkell DG. A comparison of intramuscular keterolac and pethidine in the alleviation of renal colic. Br J Urol. 1994; 74: 690–3.
  18. Turkcuer I, Serinken M, Karcioglu O, Zencir M, KeysanMK. Hospital cost analysis of management of patients with renal colic in the emergency department. Urol Res. 2010; 38(1): 29-33
  19. Gatti MFZ, Ferraz MB, Leão ER, Bussotti EA, Caliman RAM. Hospital costs of renal colic diagnosis and management in a Brazilian private emergency service. Rev Dor. São Paulo. 2013; 14(1):12.

How to Cite

Hexam, R., Rezai, M., Delbari, D., Keshmiri, Y. S., Aghdam, H., & Zohri, D. (2018). Comparison of intramuscular injection of ketorolac and conventional treatment in the field of cost-effectiveness, length of stay and pain relief in patients admitted to the emergency department with renal colic. Bali Medical Journal, 8(1), 83–87. https://doi.org/10.15562/bmj.v8i1.1260

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