Pharmacy Practice, LIU Pharmacy (Arnold and Marie Schwartz College of Pharmacy), The Brooklyn Hospital Center, Brooklyn, NY.
Pharmacy Practice, LIU Pharmacy (Arnold and Marie Schwartz College of Pharmacy), Brooklyn, NY.
Am J Ther. 2019 Jul/Aug;26(4):e487-e488. doi: 10.1097/MJT.0000000000000729.
Renal colic is defined as a flank pain radiating to the groin caused by kidney stones in the ureter (urolithiasis). Renal colic is a frequent cause of Emergency Department visits. Most renal colic cases present as acute distress and severe back and/or abdominal pain that require prompt treatment with analgesics.
Nonsteroidal anti-inflammatory drugs and opioids are traditionally used for renal colic in the Emergency Department. This trend of practice is based on clinical experience and expert opinion. Consensus guidelines that provide evidence-based approach for the management of renal colic are limited. One consensus guideline from Europe provides a systematic approach for the management of pain with the use of nonsteroidal anti-inflammatory drugss and opioids. However, no guidance is provided on how to manage patients who do not respond to these agents.
Intravenous lidocaine 120 mg in 100 mL normal saline was infused over 10 minutes for pain management for intractable renal colic unresponsive to standard therapy. Three minutes after initiation of lidocaine infusion, the patient reported numeric pain rating scale 1/10. At 5 minutes, the reported numeric pain rating scale was 0/10 and remained for 60 minutes after initiation of lidocaine infusion. No adverse events were reported during or after the infusion, and no subsequent analgesia was required.
肾绞痛是指由输尿管（尿路结石）中的肾结石引起的向腹股沟放射的侧腹痛。肾绞痛是急诊科就诊的常见原因。大多数肾绞痛病例表现为急性疼痛和严重的背部和/或腹痛，需要迅速用镇痛药治疗。
非甾体抗炎药和阿片类药物传统上用于急诊科的肾绞痛。这种实践趋势基于临床经验和专家意见。提供肾绞痛管理循证方法的共识指南有限。来自欧洲的一项共识指南提供了一种使用非甾体抗炎药和阿片类药物管理疼痛的系统方法。然而，对于那些对这些药物没有反应的患者，没有提供如何管理的指导。
对于对标准治疗无反应的难治性肾绞痛，静脉输注 100 毫升生理盐水的 120 毫克利多卡因，持续 10 分钟用于疼痛管理。在开始输注利多卡因 3 分钟后，患者报告数字疼痛评分量表为 1/10。在 5 分钟时，报告的数字疼痛评分量表为 0/10，并且在开始输注利多卡因后 60 分钟内保持不变。在输注过程中和输注后均未报告不良事件，并且不需要后续镇痛。
