Efficacy of IV Paracetamol in Patients with Renal Colic in Emergency Department
DOI:
https://doi.org/10.70749/ijbr.v2i02.241Keywords:
Renal Colic, Paracetamol, NSAIDs, Emergency DepartmentAbstract
Background: Renal colic, characterized by excruciating flank pain radiating to the groin, arises from urinary tract obstruction, triggering prostaglandin production and increased intra-renal pressure. NSAIDs are the first-line analgesics but have limitations in vulnerable populations. Intravenous paracetamol has emerged as a safer alternative with rapid analgesic effects and fewer adverse outcomes, especially in resource-limited settings. Objective: The objective is to compare the analgesic efficacy of the intravenous paracetamol and intra muscular diclofenac sodium, in the early resolution of pain in acute renal colic. Methods: This randomized controlled trial was conducted from February 2024 to April 2024 at the Emergency Department of Mayo Hospital Lahore. Patients showing clinical signs and symptoms of acute renal colic were randomly assigned to two groups. Group I (n=35) received 1 gram of intravenous paracetamol, while Group II (n=35) was given 50 mg of intramuscular diclofenac sodium. The pain intensity was evaluated using the Verbal Rating Scale (VRS) 30 minutes after treatment. Results: In this study, there were 47 male patients and 23 female patients. The mean age was 38 12 years old. After 30 minutes of administration, the pain relief in the paracetamol group (p value: <0.01) was similar to that of diclofenac group (p value: <0.01). However, the requirement of rescue analgesia was lower in the paracetamol group than diclofenac group. Conclusion: In acute renal colic patients, with the heralded side effects of non-steroidal anti-inflammatory drugs, IV paracetamol is an excellent alternative, with low risk profile and a higher analgesic efficacy.
References
Marx, J., Hockberger, R., & Walls, R. (2013). Rosen's Emergency Medicine-Concepts and Clinical Practice E-Book: 2-Volume Set. Elsevier Health Sciences.
Kaynar, M., Koyuncu, F., Buldu, İ., Tekinarslan, E., Tepeler, A., Karatağ, T., İstanbulluoğlu, M. O., & Ceylan, K. (2015). Comparison of the efficacy of diclofenac, acupuncture, and acetaminophen in the treatment of renal colic. The American Journal of Emergency Medicine, 33(6), 749–753. https://doi.org/10.1016/j.ajem.2015.02.033
Shams-Vahdati, S., Robaei, N., Habibollah, P., Jafari-Rouhi, A., Mohammadi, S., & Piri, R. (2018). Paracetamol vs. Intravenous Morphine Plus Diclofenac in Renal Colic Pain: A Randomized Clinical Trial. Nephro-Urology Monthly, 10(4). https://doi.org/10.5812/numonthly.77193
Tintinalli, J. E., Stapczynski, J. S., Ma, O. J., Yealy, D. M., Meckler, G. D., & Cline, D. M. (2016). Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 8e (Vol. 18). McGraw Hill Education. http://file.atuder.org.tr/_atuder.org/fileUpload/GCpynyVfyfpX.pdf
Ghafouri, H. B., Abazarian, N., Yasinzadeh, M., & Modirian, E. (2020). Intravenous paracetamol vs intranasal desmopressin for renal colic in the emergency department: A randomized clinical trial. Pain Medicine, 21(12), 3437-3442. https://doi.org/10.1093/pm/pnaa240
Zhili, X., Linglong, C., Shuang, J., & Baohua, Y. (2020). Comparing the analgesic effect of intravenous paracetamol with morphine on patients with renal colic pain: A meta-analysis of randomized controlled studies. The American Journal of Emergency Medicine, 38(7), 1470–1474. https://doi.org/10.1016/j.ajem.2020.03.061
Bektas, F., Eken, C., Karadenız, O., Goksu, E., Cubuk, M., & Cete, Y. (2009). Intravenous Paracetamol or Morphine for the Treatment of Renal Colic: A Randomized, Placebo-Controlled Trial. Annals of Emergency Medicine, 54(4), 568–574. https://doi.org/10.1016/j.annemergmed.2009.06.501
Grissa, M. H., Claessens, Y.-E., Bouida, W., Boubaker, H., Boudhib, L., Kerkeni, W., Boukef, R., & Nouira, S. (2011). Paracetamol vs piroxicam to relieve pain in renal colic. Results of a randomized controlled trial. The American Journal of Emergency Medicine, 29(2), 203–206. https://doi.org/10.1016/j.ajem.2009.09.019
Masoumi, K., Forouzan, A., Asgari Darian, A., Feli, M., Barzegari, H., & Khavanin, A. (2014). Comparison of clinical efficacy of intravenous acetaminophen with intravenous morphine in acute renal colic: a randomized, double‐blind, controlled trial. Emergency medicine international, 2014(1), 571326. https://doi.org/10.1155/2014/571326
Wang, X., & Ji, X. (2020). Sample Size Estimation in Clinical Research: From Randomized Controlled Trials to Observational Studies. CHEST, 158(1), S12–S20. https://doi.org/10.1016/j.chest.2020.03.010
Gu, H. Y., Luo, J., Wu, J. Y., Yao, Q. S., Niu, Y. M., & Zhang, C. (2019). Increasing nonsteroidal anti-inflammatory drugs and reducing opioids or paracetamol in the management of acute renal colic: based on three-stage study design of network meta-analysis of randomized controlled trials. Frontiers in pharmacology, 10, 96. https://doi.org/10.3389/fphar.2019.00096
Hughes, T., Ho, H. C., Pietropaolo, A., & Somani, B. K. (2020). Guideline of guidelines for kidney and bladder stones. Türk Üroloji Dergisi/Turkish Journal of Urology, 46(Supp1), S104–S112. https://doi.org/10.5152/tud.2020.20315
Holdgate, A., & Pollock, T. (2004). Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic. BMJ, 328(7453), 1401. https://doi.org/10.1136/bmj.38119.581991.55
Davenport, K., & Waine, E. (2010). The Role of Non-Steroidal Anti-Inflammatory Drugs in Renal Colic. Pharmaceuticals, 3(5), 1304–1310. https://doi.org/10.3390/ph3051304
Al, B., Sunar, M. M., Zengin, S., Sabak, M., Bogan, M., Can, B., Kul, S., Murat Oktay, M., & Eren, S. H. (2018). Comparison of IV dexketoprofen trometamol, fentanyl, and paracetamol in the treatment of renal colic in the ED: A randomized controlled trial. The American Journal of Emergency Medicine, 36(4), 571–576. https://doi.org/10.1016/j.ajem.2017.09.019
Serinken, M., Eken, C., Turkcuer, I., Elicabuk, H., Uyanik, E., & Schultz, C. H. (2011). Intravenous paracetamol versus morphine for renal colic in the emergency department: a randomised double-blind controlled trial. Emergency Medicine Journal, 29(11), 902–905. https://doi.org/10.1136/emermed-2011-200165
Pathan, S. A., Mitra, B., Straney, L. D., Afzal, M. S., Anjum, S., Shukla, D., ... & Cameron, P. A. (2016). Delivering safe and effective analgesia for management of renal colic in the emergency department: a double-blind, multigroup, randomised controlled trial. The Lancet, 387(10032), 1999-2007.
Pathan, S. A., Mitra, B., & Cameron, P. A. (2018). A Systematic Review and Meta-analysis Comparing the Efficacy of Nonsteroidal Anti-inflammatory Drugs, Opioids, and Paracetamol in the Treatment of Acute Renal Colic. European Urology, 73(4), 583–595. https://doi.org/10.1016/j.eururo.2017.11.001
Sin, B., Koop, K., Liu, M., Yeh, J.-Y., & Thandi, P. (2017). Intravenous Acetaminophen for Renal Colic in the Emergency Department: Where Do We Stand? American Journal of Therapeutics, 24(1), e12–e19. https://doi.org/10.1097/mjt.0000000000000526
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