Grill Justin, Bryant Caleb, Dunikoski Leonard, Carrasco Zach, Wisniewski Samuel J, Price Kristen
Mercy Health Muskegon, MI.
Michigan State University, East Lansing, MI.
Spartan Med Res J. 2019 Mar 4;3(3):7210. doi: 10.51894/001c.7210.
Currently, there is no standard therapy for treatment of acute renal colic. With the increased scrutiny and controversy now surrounding opioids, the authors identified a need to investigate an alternative medication for pain control. As such, they sought to determine the efficacy of sub-dissociative (i.e., low) doses (0.3 mg/kg) of ketamine in providing Emergency Department (ED) patients acute pain management for renal colic secondary to nephrolithiasis.
After institutional review board (IRB) approval, the authors conducted a non-blinded, prospective clinical study. A convenience sample of n = 34 patients from the ED of a Western Michigan-based health system with suspected renal colic received one intravenous dose of ketorolac, 30 mg if over 50 kg body weight or 15 mg if under 50 kg In patients weighing greater than 50 kg, up to two doses of sub-dissociative ketamine were then given to further control pain. Pain was assessed at times 0, 30, 60, 90 and 120 minutes.
There was a statistically significant pain reduction with administration of sub-dissociative ketamine, with 24 (69.2%) patients reporting an average reduction in pain score > 30% (t = 3.16, p = 0.004). Initial average pain scores for patients receiving sub-dissociative ketamine averaged 7.76 (SD = 2.55) on the 11-point verbal Pain Numeric Rating Scale. After a first dose of ketamine, patients' average pain score was 3.56 (SD = 0.74) at 30 minutes. After two hours, patients' average score was 2.56 (SD = 0.65), indicating that pain control was still effective over time with no statistically significant change in pain scores. Additionally, there was no statistically significant difference in pain reduction observed between genders (t = -0.192, p = 0.850).
Based on these results, sub-dissociative ketamine may be considered a reasonable and effective supplemental non-opiate treatment option for suspected renal colic in otherwise healthy 18-70-year-old patients and could provide an effective alternative to traditional therapies. Further studies utilizing this methodology with larger, more generalizable samples are needed to further validate these findings.
目前，尚无治疗急性肾绞痛的标准疗法。鉴于现在围绕阿片类药物的审查力度加大且存在争议，作者们发现有必要研究一种替代药物来控制疼痛。因此，他们试图确定亚麻醉剂量（即低剂量，0.3毫克/千克）的氯胺酮在为急诊科（ED）因肾结石继发肾绞痛的患者提供急性疼痛管理方面的疗效。
在获得机构审查委员会（IRB）批准后，作者们开展了一项非盲前瞻性临床研究。从密歇根州西部一家医疗系统的急诊科选取了n = 34例疑似肾绞痛患者的便利样本，给予一剂静脉注射酮咯酸，体重超过50千克者给予30毫克，体重低于50千克者给予15毫克。对于体重超过50千克的患者，随后给予至多两剂亚麻醉剂量的氯胺酮以进一步控制疼痛。在0、30、60、90和120分钟时评估疼痛情况。
给予亚麻醉剂量的氯胺酮后，疼痛有统计学意义的减轻，24例（69.2%）患者报告疼痛评分平均降低超过3０%（t = 3.16，p = 0.004）。在11分的语言疼痛数字评分量表上，接受亚麻醉剂量氯胺酮的患者初始平均疼痛评分为7.76（标准差 = 2.55）。给予第一剂氯胺酮后，患者在30分钟时的平均疼痛评分为3.56（标准差 = 0.74）。两小时后，患者的平均评分为2.56（标准差 = 0.65），表明随着时间推移疼痛控制仍然有效，疼痛评分无统计学意义的变化。此外，观察到不同性别之间在疼痛减轻方面无统计学意义的差异（t = -0.192，p = 0.850）。
基于这些结果，对于18至70岁的健康疑似肾绞痛患者，亚麻醉剂量的氯胺酮可被视为一种合理且有效的补充性非阿片类治疗选择，并且可为传统疗法提供有效的替代方案。需要利用这种方法并采用更大、更具普遍性的样本进行进一步研究，以进一步验证这些发现。
