Nazemian N, Torabi M, Mirzaee M Atomized intranasal vs intravenous fentanyl in severe renal colic pain management: A randomized single-blinded clinical trial. Am J Emerg Med. 2019 Oct 23:158483. doi: 10.1016/j.ajem.2019.158483. (Original study)

OBJECTIVES: Renal colic is one of the most common painful disorders in patients referred to the emergency department. The main purpose of this study was to compare the efficiency of two methods of intravenous (IVF) and intranasal (INF) fentanyl administration in pain management in patients with severe renal colic.

MATERIALS & METHODS: This was a single-blind randomized clinical trial performed on patients with severe renal colic. The severity of pain was =8 based on the Numerical Rating Scale (NRS). The efficacy of pain management was compared within and between the IVF (intramuscular Ketorolac + intravenous fentanyl) and INF (intramuscular Ketorolac + intranasal fentanyl) groups at different times points. Oral consent was obtained from all the patients.

RESULTS: Of 220 individuals, 96 (43.60%) were women and 124 (56.40%) were men. There were no significant differences between the two groups regarding the baseline pain severity, age, sex, history of urolithiasis and body mass index (BMI). The pain severity showed a significant reducing trend in both groups (p?<?0.0001). There was also a significant difference comparing the mean pain severity between groups at different times (p?<?0.0001). In each group, the severity of pain showed significant reduction compared with its prior measurement (P?<?0.0001).

CONCLUSION: Fentanyl is highly effective in controlling pain in patients with severe renal colic referring to the emergency department. Intranasal administration of fentanyl combination with ketorolac can be an appropriate, non-invasive, easy-to-use and fast alternative to the intravenous method to manage pain in these patients.

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Comments from MORE raters

Physician rater

I believe that nephrologists are rarely involved in the pain management of patients presenting to the ER with renal colic pain. As such, the information provided in this trial is interesting but of limited practical value to nephrologists.

Physician rater

This is useful information about a non-traditional form of use of a narcotic drug in renal colic.

Physician rater

I don't see the reason to use narcotics as first line agent in this population.

Physician rater

It would be interesting to know why the authors choose fentanyl and why they did not try other opiates with longer analgesic effect.
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