BACKGROUND: The pain of renal colic, mediated in part by ureteral spasm and inflammation, is often severe and difficult to control. Salbutamol has been shown to cause ureteral relaxation, but its effects on the pain of renal colic have never been studied. The objective of this trial was to investigate whether the use of intravenous salbutamol in addition to standard analgesia was associated with greater pain reduction compared with standard analgesia alone in patients presenting to emergency departments (EDs) with renal colic.
METHODS: This single-centre, double-blind, phase II, randomised, placebo-controlled trial recruited adult (=18 years) ED patients with clinically suspected renal colic. Participants were randomised in a 1:1 ratio to receive either 250 µg of intravenous salbutamol or a placebo (0.9% sodium chloride). The primary outcome was the difference in the change in pain scores (measured on a 100 mm Visual Analogue Scale) from baseline to 30 min following trial treatment administration in participants with subsequently confirmed renal colic. A modified intention-to-treat analysis was undertaken for the primary population of participants with confirmed renal colic.
RESULTS: Consent was obtained from 151 patients; 108 participants with confirmed renal colic were included in the primary outcome analysis. There was no statistical difference between groups in median change in pain score at 30 min (salbutamol group -18 mm (IQR -25 to -3), placebo group -13 mm (IQR -33 to -1), difference 5 mm (95% CI -16 to 6, p=0.575)). No significant differences were found in the secondary outcomes related to pain, patient satisfaction or opiate requirement.More adverse events (AEs) were observed in the salbutamol group (65) compared with placebo (42, p=0.02); no unexpected AEs were identified.
CONCLUSIONS: This trial has not identified a clinically or statistically significant benefit from the addition of intravenous salbutamol to standard care for patients presenting to an ED with pain caused by renal colic.
TRIAL REGISTRATION NUMBERS: The trial was registered with the European Union Drug Regulating Authorities Clinical Trials Database (EudraCT), reference 2018-004305-11. It was also registered with the ISRCTN Registry, reference 14552440.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
This relatively novel idea for treating renal colic-related pain did not appear to work. It's not clear whether this is worth further study, but it is definitely not something that clinicians should be routinely using for renal colic pain.
Physician rater
This is a phase 2 II RCT about salbutamol in pain relief for renal colic. The authors reported that in patients with confirmed kidney stone, salbutemol is does not statistically reduce pain at 30 minutes compared with placebo (normal saline). On the other hand, salbutemol increased the number of adverse events (tremors, palpitations, dizziness). The topic is quite relevant in Emergency Medicine as this is one of the most severe painful conditions in the ED. The study was well designed and their outcomes were relevant. The weakness of the study was that salbutemol is not commonly used, so not a lot of clinicians will know about this medication or this study.
, McMaster University