Treatment of Acute Renal Colic: Rectal Diclofenac Sodium

Treatment of sub abrupt nephritic Colic rectal Diclofenac SodiumTherapeutic Effects of Rectal Diclofenac Sodium and Intramuscular Pethidine Injectionin The Treatment of Acute nephritic Colic A randomized Clinical TrialMohammad Mehdi Hosseini, Abdoul-Rasoul EbrahimiAbstractrenal griping is a type of abdo minal aggravator plebeianly ca hired by obstructive stones. The aims of this aim were to evaluate safety and might of rectal diclofenac atomic number 11 ( RD ) in clear-sighted renal gripes and compare it with intramuscular pethidine ( scamp) injection. In an interventional prospective double blind randomized control exertion with 541 endurings, which referred to fate Department ascribable to acute renal colic, RD and IMP were administrated to 266 forbearing (as collection I) and 275 patients (as ag mathematical group II), respectively. Pain relief was measured through asking the patient by the physician at 10, 20 and 30 min later on(prenominal) victimisation of re spective drugs in each group. In group I, anodyne cause of RD were appeared in 121 patients (45.5%) later 10 min, 191 patients (71.9%) after(prenominal) 20 min and 233 patients (87.5%) after 30 min. 33 patients (12.5%) had no answer to RDS . In group II, analgesic set up of IMP were appeared in 123 patients (44.7%) after 10 min, 191 patients (69.5%) after 20 min and 254 patients (92.3%) after 30 min. 21 patients (7.7%) had no response to IMP. Our results demonstrated that although, at that place were no substantive differences in analgesic personal do between two drugs (P=0.06), but, repayable to availability, cheapness, safety and self administration properties, use of sodium diclofenac in suppository form is highly recommended in renal colic.Keywords Renal colic diclofenac sodium pethidine analgesia.IntroductionRenal colic is a common urological tinge at the emergency department, often ca employ by the movement of ureteral stones and characterized by severe fuss. Patie nts describe this anguish as the most severe and torture some situation ever experienced (Ay et al. 2013). This condition afflicts 512% of the universe in industrial societies at least once in their keep sentence time and its recurrence rate is approximately 50% (Esmailian and Keshavarz 2014). The unhinge is ordinarily attributed to contraction of ureter soft muscles in response to the presence of stone (Holdgate and pollack 2004). Therefore, the most important consideration in the emergency management of renal colics is pain control/relief (Esmailian and Keshavarz 2014).Both parenteral opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly use to provide relief from renal colic (Bektas et al. 2009). For relieving this pain, morphia and pethidine in the traditional approach were used, but, due to their side effects such as addictive effects, constipation, respiratory depression, and mental changes,, using of them is lessen and replaced by NSAIDs (Kalb et al . 2010 Muslumanoglu and Tepeler 2008). Experimental works suggest that prostaglandins (PGs) play an important map in producing pain in renal colic and therefore, antiprostaglandins cigarette go past or diminish this type of pain (Hetherington and Philp 1986 Thompson et al. 1989).Diclofenac, 2-(2-(2,6-dichlorophenylamino)phenyl)acetic acid, is an NSAID taken or applied to reduce inflammation and as an analgesic reducing pain in certain conditions such as renal colic. The exact mechanics of action is not entirely known, but the primary mechanism trusty for its analgesic action is thought to be inhibition of PG synthesis by inhibition of cyclooxygenase, one of the basic enzymes in the PG synthesis pathway (Dutta et al. 2000). On the other hand, pethidine is a once popular synthetic opioid analgesic of the phenylpiperidine pattern (MacPherson and Duguid 2008). The specific adverse event of vomiting showed a clear stand with opioids, in particular pethidine. Although no studies rep orted serious adverse events, the con follow-up period and failure to specific eachy record renal disfunction and gastrointestinal bleeding means these results should be interpreted cautiously (Holdgate and pollock 2004). Given these findings, when a single bolus of analgesia is used, an NSAID rather than an opioids was recommended. However, in some condition such as severe pain using of opioids is inevitable. Therefore, in this study, we compared the efficacy of analgesic therapy of rectal diclofenac sodium (RD) and intramuscular pethidine (IMP), commonly like in emergency departments in our country in patients with renal colic.Participants and rulesA. Patients and study designAn interventional prospective multicenter double blind randomized control trial (RCT) with five hundred forty one eligible patients which had renal colic and referred to Motahhary and Peymanieh Hospitals of Jahrom and Faghihi and Nemazee Hospitals of Shiraz between Dec 2005 to Apr 2007 was done. The study protocol and informed consent were authorize by the Ethics Committee at Jahrom University of Medical Sciences. All patients who enrolled in this study, were read, accepted and signed the consent form. Participant, with age between 17 to 52 years, randomly allocated in two parallel groups, RD (single dose of 100 mg) and IMP (single dose of 50 mg) in the approximately ratio of 11 (266 and 275 patients, respectively). Randomization was performed using a computer-generated random permuted block method. Patients with history of allergic reaction to NSAIDs, hemorrhoids and anal fissures, peptic ulcers, coagulopathy, inflammatory bowel disease, pregnancy, ischemic coronary diseases, degenerative obstructive pulmonary disease, and liver or renal failure were excluded from the study.B. Method of measurementSubjects reported pain and its compensate at 10, 20 and 30 min after drug receiving and according to satisfying decrease in pain intensity at each time (decrease in pain intensity mor e than 50%), the patient was placed in the regard groups. Subjects were blind to their previous reports. Our outcome measure was the change in pain intensity at 10, 20, 30 and more than 30 min. The participants that enrolled in group 3 (significant decrease in pain after 30 min) were comprise from patient in group 1 (significant decrease in pain after 10 min) and 2 (significant decrease in pain after 20 min) and there was similar pattern between group 2 and 1.C. Statistical analysisSPSS for Windows version 16 package program was used for statistical analysis of the data.t test and analysis of variance were used for analysis of variables. Results were expressed as n (number of patients), and office (%). According to the results, a P value 0.05). Distribution of patients according to time of responding to analgesic effects of RD and IMP is displayed in Figure 2. According to these data, the percentage of patients that showed defined decline in pain at 10 and 20 min after using of d rug in RD was higher than IMP. However these differences were not significant (P=0.06).DiscussionIn this study, the analgesic efficacy of rectal sodium diclofenac and intramuscular pethidine administration in patients which suffered from renal colic were evaluated. Our results demonstrated that although, the percent of patients with lessened pain in 10 and 20 min after using of RD was higher than IMP but, this difference was not significant. Therefore, the efficacy of these two drugs is similar. However, due to availability, cheapness, safety and self administration properties, use of RD is highly recommended in renal colic in compare to IMP. In two previously studies, the efficacy of using of sodium diclofenac versus pethidine in acute renal colic were evaluated and reported. In the study of Hetherington and Philp (1986) on 58 renal colic patients, it has been think that 75 mg of sodium diclofenac, IM, was more effective than 100 mg of Pethdine, IM, in the management of acute ren al colic and has fewer side effects (Hetherington and Philp 1986). Also, Thompson et al (1989) reported that diclofenac suppositories provided potent, specific analgesia in renal colic. They also think that, diclofenac is superior to pethidine, because its effect starting at a similar time but lasting longer (Thompson et al. 1989).On the other hand, this fact that diclofenac can be self administered and is not an opiate makes it a useful drug in general practice, especially for patients with recurrent renal colic. Pethidine as a synthetic opioids, is about one tenth as potent as morphine and due to having more lipid solubility than morphine, elimination half life of two to four hours and duration of action of only two to trinity hours were considered for it (Foley 1985). At 2000, in a double blind RCT, analgesic efficacy, patient satisfaction and side effects of morphine and pethidine in patients with clinically suspect renal colic were evaluated. Although, their data demonstrated that there was no significant difference between morphine and pethidine with respect to any of the parameters measured, but they concluded that because of the well known adverse effects that may be associated with pethidine use, morphine should be the preferred agent in suspected renal colic, when an opioid analgesic is to be used (O&aposConnor et al. 2000). In addition, it has been reported that norpethidine, the predominant metabolite of pethidine, is potentially deadly and causing central nervous system excitability such as tremors, myoclonus or seizures. Also, accumulation of norpethidine has also been seen in patients with normal kidneys, particularly with monumental doses or frequent dosing intervals (Marinella 1997).Finally, due to adverse effects of pethidine and its metabolite, norpethidine and also due to possibility of pethidine addiction, we believe that diclofenac suppositories should be considered as the first line handling of renal colic, both in hospital and in ge neral practice. exculpationThe authors thank the staff physians and nursing team of the Emergency Department of the Motahhary and Peymanieh Hospitals of Jahrom and Faghihi and Nemazee Hospitals of Shiraz and all other people who help in this study.ReferencesAy MO, Sebe A, Kozaci N, Satar S, Acikalin A, Gulen M, Acehan S (2013) par of the Analgesic Efficacy of Dexketoprofen Trometamol and Meperidine HCl in the Relief of Renal Colic. 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British Medical Journal 292 (6515)237-238Holdgate A, Pollock T (2004) Nonsteroidal anti-inflammatory drugs (NSAIDs) versus opioids for acute renal colic. Cochrane Database Syst Rev 11-54Kalb B, Sharma P, Salman K, Ogan K, Pattaras JG, Martin DR (2010) Acute abdominal pain is there a potential role for MRI in the setting of the emergency department in a patient with renal calculi? Journal of magnetised Resonance Imaging 32 (5)1012-1023MacPherson RD, Duguid MD (2008) Strategy to Eliminate Pethidine purpose in Hospitals. Journal of Pharmacy Practice and Research 38 (2)88-89Marinella MA (1997) Meperidine-induced generalized seizures with normal renal function. South Medical Journal 90556-558Mus lumanoglu AY, Tepeler A (2008) Renal kolik tani ve tedavisi. Marmara Med J 21187-192O&aposConnor A, Schug SA, Cardwell H (2000) A comparison of the efficacy and safety of morphine and pethidine as analgesia for suspected renal colic in the emergency setting. Journal of Accident and Emergency Medicine 17 (4)261-264Thompson JF, Pike JM, Chumas PD, Rundle JS (1989) Rectal diclofenac compared with pethidine injection in acute renal colic. British Medical Journal 299 (6708)1140-1141Figure 1. Number and percentage of patients which response/non response to rectal sodium diclofenac and intramuscular pethidine.Figure 2. similitude on the efficacy of rectal sodium diclofenac and intramuscular pethidine in attenuating of renal colic pain.