1996 Oct 10;116(24):2873-4. They are highly effective in reducing the number of new colic episodes and readmissions to hospital; however they do not appear to have any effect on the time to stone passage or the likelihood of stone passage in renal colic. WebIndications and dose Unlicensed use Contra-indications Cautions Interactions Side-effects Allergy and cross-sensitivity Conception and contraception Pregnancy Breast feeding Hepatic impairment Renal impairment Patient and carer advice Medicinal forms Related treatment summaries Other drugs in class Interactions Indications and dose Renal Colic Labanaris A.P., Kuhn R., Schott G.E., Zugor V. Perirenal haematomas induced by extracorporeal shock wave lithotripsy (ESWL). How to examine? Careers, Unable to load your collection due to an error. single doses of piroxicam administered sublingually and aspirin. In a canine in vivo model of acute obstruction, the mean peristaltic rate, baseline pressure and peak pressures above the level of obstruction were all shown to increase significantly [20]. West J Emerg Med 2017;18(4):77579. Recruitment, allocation and follow-up of participants. Oral diclofenac in the prophylactic treatment of recurrent renal colic: A double blind comparison with placebo. Bleumink G.S., Feenstra J., Sturkenboom M.C., Stricker B.H. This is the first comparative study of intramuscular drotaverine hydrochloride vs intramuscular diclofenac sodium to evaluate efficacy and safety in management of pain associated with renal colic. pain. well recognised that health care workers underestimate the severity of 1996;30(3):358-62. doi: 10.1159/000474196. Ultrasonography versus computed tomography for suspected nephrolithiasis. Efficacy and safety of tamsulosin in medical expulsive therapy for distal ureteral stones with renal colic: A multicenter, randomized, double-blinded, placebo-controlled trial. Accessibility Disclaimer. number of patients subsequently referred to hospital. Among 82 patients, 77 patients did not fulfill inclusion criteria and five patients declined to participate in the study. Inclusion in an NLM database does not imply endorsement of, or agreement with, Successful management ofrenal tract pain necessitates a combination of analgesia and medical expulsive therapy, failing which surgical intervention is required. Drotaverine is an effective spasmolytic, inhibiting PDE type IV in the smooth muscle cells, accompanied by a mild calcium-channel blocking effect with no anticholinergic effect [4]. Tidsskr Nor Laegeforen. In a previous study done by Romics et al., drotaverine showed effectiveness in 79% patients with renal colic [4] and our study result (82%) corroborates with this study. MeSH The three phases are: acute insidious, constant, Laerum [20] randomised patients to 7 days diclofenac 50 mg tds (n = 41) or placebo tds (n = 39). Conversely below the level of obstruction, the mean peristaltic rate remained unchanged but the baseline and peak pressures generated were both significantly reduced. A reduction in the rate of spontaneous contraction was seen, with abrupt cessation of all spontaneous activity following the application of diclofenac at 10-5 M concentration. This may be associated with storage-related lower urinary tract symptoms (LUTS), such as urinary frequency, urgency, nocturia and incontinence.8 None of the aforementioned symptoms reliably predicts the location of the offending stone in the ureter. doi: 10.1080/0886022X.2016.1215221. dehydration, high salt and protein intake. Accurate diagnosis and early initiation of adequate analgesia and medical expulsive therapy in appropriate patient groups can help improve quality of patient care and reduce emergency department presentations and healthcare costs. Rescue therapy is defined as the need of intramuscular tramadol (100 mg) injection if VAS at 60 minutes is more than 50% the initial VAS. Pathan SA, Mitra B, Cameron PA. A systematic review and meta-analysis comparing the efficacy of nonsteroidal anti-inflammatory drugs, opioids, and paracetamol in the treatment of acute renal colic. VAS decreased significantly (P < 0.001) with both drotaverine (52.4%) and diclofenac (49%) at 30 minutes. Single dose oral diclofenac for postoperative pain. Patients were excluded if they had a history of peptic ulcer disease, asthma, bleeding disorder (use of oral anticoagulant); need for immediate surgical or other intervention; suspected hypersensivity to drotaverine or NSAIDs; spasmolytics or analgesics received within 6 hours before presenting to ED; tranquillizing or muscle-relaxant therapy used within 3 days; second- or third-degree arterioventricular block; known or suspected pregnancy; known progressive malignant disease; clinically unstable renal, hepatic or cardiac insufficiency (serum glutamate-oxalacetate transaminase >180 U/L, creatinine >250 mmol/L). Available at www.aihw.gov.au/reports-data/myhospitals/sectors/emergency-department-care [Accessed 16 April 2021]. NSAIDs like diclofenac sodium are commonly used drugs for analgesia in renal colics in the Indian setup. To compare the efficacy of sublingual piroxicam 40 mg with intramuscular diclofenac 75 mg in treatment of acute renal colic. Furthermore, the use of cyclo-oxygenase 2 inhibitors (now available Primary outcome measure was pain intensity score at 30 and 60 minutes. Intramuscular diclofenac: 25 year worldwide safety perspective is vital to consider We think it important to clarify some issues raised by correspondence in relation to the recent article by Wright et al in the BMJ regarding the safety of intramuscular diclofenac in the treatment of renal colic1. Is there an association between serum soluble interleukin-2 receptor levels and syndrome severity in persistent Complex Regional Pain Syndrome? Fifty patients were allocated to the drotaverine group who received two ampoules of drotaverine hydrochloride 80 mg single intramuscular injection and another 50 patients were allocated to the diclofenac group who received diclofenac sodium 75 mg single intramuscular injection. Renal Colic The use of rescue medication was 32.5% in the GK versus 47.5% in the GD (P=0.17). generally responds better to non-steroidal anti-inflammatory drugs in a randomized double-blinded controlled trial, showed that drotaverine, a selective PDE IV inhibitor, significantly reduced acute renal colic when compared with placebo [4]. doi: 10.2147/DDDT.S99330. Readmission rate to Oslo Emergency Hospital/other hospitals were 10 and 67% (p < 0.001). Referred and migratory pain are hallmarks of this condition and are unique to renal colic because of the progressive passage of the stone along the ureter. Concomitant fevers might be indicative of other inflammatory or infective processes or signal the presence of an infected obstructed kidney, which is a urological emergency. A comparative, Davenport K., Timoney A.G., Keeley F.X., Jr. Effect of smooth muscle relaxant drugs on proximal human ureteric activity, http://creativecommons.org/licenses/by/3.0/, http://www3.interscience.wiley.com/journal/123299889/abstract, Indomethacin 25mg PO bd + 100 mg PR nocte. When a renal calculus advances into the ureter, ureteric spasms occur secondary to a massive release of prostaglandins.7 Renal stones in the upper two-thirds of the ureter tend to present with flank and renal angle tenderness. Adult renal colic is a frequent lombo-abdominal painful syndrome in emergencies. Coll D.M., Varanelli M.J., Smith R.C. Laerum E., Omundsen O.E., Gronseth J.E., Christianson A., Fagertun H.E. Failure to relieve pain in renal colic, defined as requirement for rescue therapy, occurs in 7% to 39% with NSAIDs [9]. Federal government websites often end in .gov or .mil. Medical expulsive therapy (MET) has been studied extensively to determine whether it reduces interval time for passage of stones if surgical intervention is not immediately indicated. Laerum E, Ommundsen OE, Gronseth JE, et al. Epub 2017 Nov 25. Renal tract pain is a common presentation to a general practitioner (GP) or emergency department, accounting for approximately 75% of presentations due to disorders of the genitourinary system.1 Ureteric calculi causing obstruction are among the most commonly identifiable causes. doi: 10.1089/end.2015.0109. Patients usually describe this condition as the worst of all maladies, the most sudden, the most painful, and the most irremediable pain[1]. Moreover, it may cause a diuresis, which in the presence of an acute urinary obstruction can lead to increased pain, extravasation of urine, and formation of a urinoma, while having no effect on the passage of the stone.2. Baseline demographic data and clinical characteristics of the patients (N = 100) participated in the study. In younger individuals (ie those aged <50 years) and those more susceptible to radiation risk, such as pregnant women, KUB ultrasonography is a useful alternative first-line imaging tool to identify calculi present in the renal calyx, pelvis, proximal and distal ureter. Scenario: Management of acute renal or ureteric colic - CKS Diclofenac Dosage Managing acute This follows the discovery that -adrenergic receptors are present in high density along the distal ureter.28 Several medications have been trialled, including -blockers, calcium channel blockers, steroids and phosphodiesterase type 5 (PDE5) inhibitors.29 The theory was that medications that could relax ureteral smooth muscle without losing peristalsis or reduce ureteral oedema would hasten passage of stones into the bladder. Federal government websites often end in .gov or .mil. The aim of this article is to present current evidence-based recommendations for renal tract pain to assist in its diagnosis, assessment and management. Oestreich MC, Vernooij RW, Sathianathen NJ, et al. Five patients in the drotaverine group and six patients in the diclofenac group needed rescue medication. Selective inhibition of COX II improves gastrointestinal tolerance but still has a detrimental effect on renal and cardiac function in those with pre-existing disease. Diagnostics What do need to examine? Its place in analgesic armamentarium can be confirmed by a double-blind, randomized, large population clinical trials. doi: 10.1016/s0022-5347(17)36261-4. doi: 10.1056/NEJMoa1404446. Barden J, Edwards J, Moore RA, McQuay HJ. The initial VAS was elevated in both groups but the difference was not significant. Competing interests: Amitabh Dash, MD and others, Intramuscular Drotaverine and Diclofenac in Acute Renal Colic: A Comparative Study of Analgesic Efficacy and Safety, Pain Medicine, Volume 13, Issue 3, March 2012, Pages 466471, https://doi.org/10.1111/j.1526-4637.2011.01314.x. During this period, the patients were monitored continuously for possible side effects and the vital signs were recorded at 30-minute intervals. The mean changes from baseline to 60 minutes postdrug were 48.78 mm (61.3%) and 48.46 mm (60.4%) in the drotaverine group and diclofenac group, respectively, and this change was also statistically nonsignificant (P = 0.82). Jindai G, Ramachandani P. Acute flank pain secondary to urolithasis: Radiologic evaluation and alternate diagnoses. While clinical information is lacking in this area we believe that it is worthy of further analysis. In conclusion, oral treatment with diclofenac was effective as short-term prophylaxis of new colic episodes, especially during the first 4 days, and reduces the number of hospital readmissions significantly. The mean time interval to stone passage was slightly lower in the indomethacin group at 82 hours as opposed to 89 hours for placebo (p > 0.1), however the groups were small and the time to stone passage was short which would make it difficult to identify a significant difference. The Role of Non-Steroidal Anti-Inflammatory Drugs in Renal Colic. Unable to load your collection due to an error, Unable to load your delegates due to an error. Grenabo [22] used indomethacin (n = 37) vs. placebo (n = 41) for 7 days and found the rate of stone passage within these 7 days was not influenced by indomethacin (22/37 and 25/41 cases). the efficacy and tolerance of NSAIDs in the treatment of renal colic was the same for diclofenac and ketoprofen. Pathan SA, Mitra B, Straney LD, Afzal MS, Anjum S, Shukla D, Morley K, Al Hilli SA, Al Rumaihi K, Thomas SH, Cameron PA. Lancet. National Library of Medicine Ketoprofen versus Diclofenac sodium in the treatment of [Use of sodium diclofenac in acute renal colic] - PubMed BMJ 2002;325:1408-1412. Categorical data, expressed in 2 2 contingency table, were tested by Fischer's test. Clipboard, Search History, and several other advanced features are temporarily unavailable. Result. 2014 Dec;42(6):541-7. doi: 10.1007/s00240-014-0708-6. Spasmolytic effect of anticholinergic drugs is inconsistent and transient. and transmitted securely. Matlaga BR, Shah OD, Assimos DG. Clipboard, Search History, and several other advanced features are temporarily unavailable. The drug effectiveness is defined as 50% decrease in pain intensity 60 minutes after intramuscular administration, without exacerbation during the following 2 hours, as well as the need for rescue medication and the presence of adverse effects.