• Usama Said Shannan Al-Khalasi, Awatif Khamis Said Al-Sarrai Al-Alalawi, Mahmood Al-Jufaili, Abdullah Al-Reesi, Ibrahim Al-Zakwani, Muzna Said Rashid Al-Asmi, Fatma Bader Al-Riyami, and Ramesh Vishwakarma.
• Emergency Medicine Residency Training Program, Oman Medical Specialty Board, Muscat, Oman.
• Ann Emerg Med. 2024 Mar 1; 83 (3): 217224217-224.

Study ObjectiveAtomized intranasal (IN) drug administration offers an alternative to the intravenous (IV) route. We aimed to evaluate the analgesic efficacy of IN versus IV ketorolac in emergency department patients with acute renal colic.MethodsWe conducted a double-blind, randomized controlled trial on adult patients (aged 18 to 64 years) with severe renal colic and numerical rating scale pain ratings ≥7.0. They were randomly assigned (1:1) to receive single doses of either IN or IV ketorolac. Our main outcomes were differences in numerical rating scale reduction at 30 and 60 minutes. A 95% confidence interval (CI) was calculated for each mean difference, with a minimum clinically important difference set at 1.3 points. Secondary outcomes included treatment response, adverse events, rescue medications, and emergency department revisits. We analyzed using intention-to-treat.ResultsA total of 86 and 85 patients with similar baseline characteristics were allocated to the IV and IN groups, respectively. Mean numerical rating scale scores were 8.52 and 8.65 at baseline, 3.85 and 4.67 at 30 minutes, and 2.80 and 3.04 at 90 minutes, respectively. The mean numerical rating scale reduction differences between the IV and IN groups were 0.69 (95% CI -0.08 to 1.48) at 30 minutes and 0.10 (95% CI -0.85 to 1.04) at 60 minutes. There were no differences in secondary outcomes.ConclusionNeither IN or IV ketorolac was superior to the other for the treatment of acute renal colic, and both provided clinically meaningful reductions in pain scores at 30 to 60 minutes.Copyright © 2023 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

32 keywords...

hide…