Comparison of the Analgesic Effect of Ketamine and Midazolam with Paracetamol (Acetaminophen) and Ketorolac in Renal Colic Patients: A Clinical Trail
DOI:
https://doi.org/10.31661/gmj.v14i.3593Abstract
Background: Renal colic is the most prevalent symptom of urinary stones, and it is quite painful. This study aimed to determine the effect of the Ketamine and Midazolam combination and compare it with the acetaminophen (paracetamol or Apotel) and Ketorolac (Toradol) combination in pain management of patients with renal colic in the emergency department (ED).
Materials and Methods: In this double-blind clinical trial study, 200 renal colic patients admitted to the ED with more than 8 Numeric Rating Scale (NRS) of primary pain were divided into two groups by random blocking: one group received intravenous Ketamine (0.4 mg/kg), and intravenous Midazolam (at a dose of 0.016 mg/kg) and the other group received intravenous Ketorolac (30 mg) and intravenous acetaminophen (15 mg/kg). After that, we measured patients’ pain by NRS at 1, 5, 10, 15, 30, and 45 min after the procedure. The data were analyzed using IBM SPSS 21.0 software.
Results: 124 (62.0%) of 200 patients were men. Initial pain scores were 9(10-9) for Ketamine + Midazolam and 10(10-9) for Acetaminophen + Ketorolac.Linear regression was performed to compare the two groups’ adjusted pain scores, correcting for initial pain. The ultimate pain score increased by.392 units for each unit of starting pain. Group and time had significant effects (5.553, -.035, P=.001, respectively). Acetaminophen + Ketorolac had a higher mean pain score than Ketamine + Midazolam at all post-intervention time intervals. During the trial, both groups’ discomfort decreased significantly. Conclusion: The combination of Ketamine and Midazolam was more effective than Acetaminophen and Ketorolac in relieving the pain in renal colic. Therefore, if routine medications are contraindicated, a combination of Ketamine and Midazolam is recommended for pain control in patients with renal colic.
References
Wang X, Cao Y, Hu J, Jia L-C, Li B, Liu B et al. Effect of Early-Intervention Acupuncture on Pain Relief Among Emergency Department Patients with Suspected Acute Renal Colic Due to Urinary Calculi: Study Protocol for a Randomized Clinical Trial. Journal of Pain Research. 2024;17(null):3831-9.
https://doi.org/10.2147/JPR.S475466
Abdulrasheed H, Adenipekun A, Mohsin MS, Khattak MA, Elsayed W, Cheema H et al. Audit of the Acute Management of Renal Colic in District Hospitals Within a National Health Service Trust. Cureus. 2024;16(9):e69825.
https://doi.org/10.7759/cureus.69825
Qu Z, Wang T, Tu J, Yao W, Pei X, Jia L et al. Efficacy and Safety of Acupuncture in Renal Colic Caused by Urinary Calculi in Adults: A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine. 2022;2022(1):7140038.
https://doi.org/10.1155/2022/7140038
Bhattacharya S, Joshi NK, Jain YK, Bajpai N, Bhardwaj P, Chaturvedi M et al. Dietary Determinants of Renal Calculi: A Case-Control Study From a Tertiary Care Hospital of Western Rajasthan. Cureus. 2022;14(11):e31460.
https://doi.org/10.7759/cureus.31460
Stamatelou K, Goldfarb DS. Epidemiology of Kidney Stones. Healthcare. 2023;11(3):424.
https://doi.org/10.3390/healthcare11030424
Lee JY, Andonian S, Bhojani N, Bjazevic J, Chew BH, De S et al. Canadian Urological Association guideline: Management of ureteral calculi-Full-text. Canadian Urological Association Journal. 2021;15(12):E676.
https://doi.org/10.5489/cuaj.7581
Sotoodehnia M, Farmahini-Farahani M, Safaie A, Rasooli F, Baratloo A. Low-dose intravenous ketamine versus intravenous ketorolac in pain control in patients with acute renal colic in an emergency setting: a double-blind randomized clinical trial. Korean J Pain. 2019;32(2):97-104.
https://doi.org/10.3344/kjp.2019.32.2.97
Klomjit N, Ungprasert P. Acute kidney injury associated with non-steroidal anti-inflammatory drugs. European Journal of Internal Medicine. 2022;101:21-8.
https://doi.org/10.1016/j.ejim.2022.05.003
Morteza-Bagi HR, Amjadi M, Mirzaii-Sousefidi R. The Comparison of Apotel plus Low Dose of Morphine and Full Dose of Morphine in Pain Relief in Patients with Acute Renal Colic. Addiction & Health. 2015;7(1-2):66-73.
Seyhan AU, Yılmaz E. Treatment of Renal Colic by Nerve Blockade with Lidocaine Versus Intravenous Dexketoprofen. Age. 2021;70(55.56):126.
Eskew J, Kelly T, Ode G. Ketorolac as a Local Analgesic in Orthopaedic Conditions: A Systematic Review of Safety and Efficacy. Current Orthopaedic Practice. 2023;34(4):142-59.
https://doi.org/10.1097/BCO.0000000000001215
Jaballah R, Toumia M, Youssef R, Ali KBH, Bakir A, Sassi S et al. Piroxicam and paracetamol in the prevention of early recurrent pain and emergency department readmission after renal colic: Randomized placebo-controlled trial. Academic Emergency Medicine. 2025;32(2): 158-164.
https://doi.org/10.1111/acem.14996
Thia I, Saluja M. An update on management of renal colic. Australian Journal of General Practice. 2021;50(7):445-9.
https://doi.org/10.31128/AJGP-11-20-5751
Nasar AA, Ahmad A, Saleem S, Bary A, Sarfraz J, Amjad M et al. Efficacy of IV Paracetamol in Patients with Renal Colic in Emergency Department. Indus Journal of Bioscience Research. 2024;2(02):541-5.
https://doi.org/10.70749/ijbr.v2i02.241
Freo U, Ruocco C, Valerio A, Scagnol I, Nisoli E. Paracetamol: a review of guideline recommendations. Journal of clinical medicine. 2021;10(15):3420.
https://doi.org/10.3390/jcm10153420
Simonini A, Brogi E, Cascella M, Vittori A. Advantages of ketamine in pediatric anesthesia. Open Medicine. 2022;17(1):1134-47.
https://doi.org/10.1515/med-2022-0509
Natoli S. The multiple faces of ketamine in anaesthesia and analgesia. Drugs Context. 2021;10:2020-12.
https://doi.org/10.7573/dic.2020-12-8
Hirota K, Lambert DG. Ketamine; history and role in anesthetic pharmacology. Neuropharmacology. 2022;216:109171.
https://doi.org/10.1016/j.neuropharm.2022.109171
Peter J-U, Dieudonné P, Zolk O. Pharmacokinetics, Pharmacodynamics, and Side Effects of Midazolam: A Review and Case Example. Pharmaceuticals. 2024;17(4):473.
https://doi.org/10.3390/ph17040473
Rao A, Tiwari S. Understanding Midazolam: The Key to Its Safe Clinical Use Midazolam in Pediatric Dentistry. Springer. 2024; :9-22.
https://doi.org/10.1007/978-3-031-45147-8_2
Noor N, Legendre R, Cloutet A, Chitneni A, Varrassi G, Kaye AD. A comprehensive review of remimazolam for sedation. Health psychology research. 2021;9(1):24514.
https://doi.org/10.52965/001c.24514
Khan MT, Khan AR, Rohail S, Raza FA, Ahmed S, Siddiqui A et al. Safety of procedural sedation in emergency department settings among the adult population: a systematic review and meta-analysis of randomized controlled trials. Internal and Emergency Medicine. 2024;19(5):1385-403.
https://doi.org/10.1007/s11739-024-03697-2
Nugent SM, Lovejoy TI, Shull S, Dobscha SK, Morasco BJ. Associations of Pain Numeric Rating Scale Scores Collected during Usual Care with Research Administered Patient Reported Pain Outcomes. Pain Med. 2021;22(10):2235-41.
https://doi.org/10.1093/pm/pnab110
Laskowski K, Stirling A, McKay WP, Lim HJ. A systematic review of intravenous ketamine for postoperative analgesia. Can J Anaesth. 2011;58(10):911-23.
https://doi.org/10.1007/s12630-011-9560-0
Safi F, Rabiee L, Shokrpour M, Kamali A. Comparison of midazolam and dexmedetomidine for pain relief during and after hysterosalpingography in women with infertility. J Med Life. 2019;12(2):173-7.
https://doi.org/10.25122/jml-2019-0013
Persson J. Ketamine in pain management. CNS Neurosci Ther. 2013;19(6):396-402.
https://doi.org/10.1111/cns.12111
Reede K, Bartholomew R, Nielsen D, Ahmeti M, Zreik K. Ketamine in Trauma: A Literature Review and Administration Guidelines. Cureus. 2023;15(11):e48099.
https://doi.org/10.7759/cureus.48099
Forouzan A, Masoumi K, Motamed H, Esfahani SRN, Delirrooyfard A. Comparison of the Analgesic Effect of Intravenous Ketamine versus Intravenous Morphine in Reducing Pain of Renal Colic Patients: Double-Blind Clinical Trial Study. Rev Recent Clin Trials. 2019;14(4):280-5.
https://doi.org/10.2174/1574887114666190705122727
Vosoughin M, Mohammadi S, Dabbagh A. Intravenous ketamine compared with diclofenac suppository in suppressing acute postoperative pain in women undergoing gynecologic laparoscopy. J Anesth. 2012;26(5):732-7.
https://doi.org/10.1007/s00540-012-1399-1
Tran KP, Nguyen Q, Truong XN, Le V, Le VP, Mai N et al. A comparison of ketamine and morphine analgesia in prehospital trauma care: a cluster randomized clinical trial in rural Quang Tri province, Vietnam. Prehosp Emerg Care. 2014;18(2):257-64.
https://doi.org/10.3109/10903127.2013.851307
Kerguelen Murcia D, Li JS, Phatak UR. Impact of intra-operative ketamine on postoperative outcomes in abdominal surgery: a narrative review. Translational Gastroenterology and Hepatology. 2024;9: 25.
https://doi.org/10.21037/tgh-23-97
Sener S, Eken C, Schultz CH, Serinken M, Ozsarac M. Ketamine with and without midazolam for emergency department sedation in adults: a randomized controlled trial. Ann Emerg Med. 2011;57(2):109-14.e2.
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Galen Medical Journal
This work is licensed under a Creative Commons Attribution 4.0 International License.
