Snir Nimrod, Moskovitz Boaz, Nativ Ofer, Margel David, Sandovski Uri, Sulkes Jacqueline, Livne Pinchas M, Lifshitz David A
Institute of Urology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.
J Urol. 2008 Apr;179(4):1411-4. doi: 10.1016/j.juro.2007.11.053. Epub 2008 Mar 4.
We assessed the efficacy of papaverine hydrochloride, a commonly used smooth muscle relaxant, for the treatment of renal colic as a single agent and in combination with sodium diclofenac.
A prospective, single-blind clinical study was performed at 2 centers. A total of 86 patients with acute renal colic were randomized to 3 treatment groups of 120 mg intravenous papaverine hydrochloride (29), 75 mg intramuscular sodium diclofenac (30), and papaverine hydrochloride plus sodium diclofenac (27). Pain intensity was assessed with the Visual Analog Scale at 0, 20 and 40 minutes after treatment. Further analgesia given at patient request consisted of 1 mg/kg intramuscular meperidine. Urinalysis, complete blood evaluation and imaging were performed in all patients. All adverse effects were recorded.
Baseline characteristics were similar in the 3 groups. Pain intensity decreased significantly (p <0.01) after 20 and 40 minutes in all groups. Papaverine hydrochloride was as effective as sodium diclofenac in alleviating pain and the combined treatment group showed a slight trend of more rapid relief. Significantly more patients in the papaverine group required further analgesia and 4 patients (14.8%) reported minor adverse effects (dizziness in 3, sleepiness in 1).
Papaverine hydrochloride is as effective as sodium diclofenac for the short-term relief of acute renal colic pain and may be advantageous in patients with contraindications for nonsteroidal anti-inflammatory drugs. However, sodium diclofenac appears to provide a longer effective analgesia.
我们评估了常用平滑肌松弛剂盐酸罂粟碱单药治疗及与双氯芬酸钠联合治疗肾绞痛的疗效。
在2个中心进行了一项前瞻性单盲临床研究。总共86例急性肾绞痛患者被随机分为3个治疗组，分别接受120mg静脉注射盐酸罂粟碱（29例）、75mg肌肉注射双氯芬酸钠（30例）以及盐酸罂粟碱加双氯芬酸钠（27例）治疗。在治疗后0、20和40分钟，使用视觉模拟量表评估疼痛强度。根据患者要求给予的进一步镇痛药物为1mg/kg肌肉注射哌替啶。对所有患者进行了尿液分析、全血评估和影像学检查。记录所有不良反应。
3组患者的基线特征相似。所有组在治疗20和40分钟后疼痛强度均显著降低（p<0.01）。盐酸罂粟碱在缓解疼痛方面与双氯芬酸钠效果相当，联合治疗组显示出疼痛缓解更快的轻微趋势。罂粟碱组需要进一步镇痛的患者明显更多，4例患者（14.8%）报告有轻微不良反应（3例头晕，1例嗜睡）。
盐酸罂粟碱在短期缓解急性肾绞痛疼痛方面与双氯芬酸钠效果相当，对于有非甾体抗炎药禁忌证的患者可能具有优势。然而，双氯芬酸钠似乎能提供更长时间的有效镇痛。
