Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Urology, University of Massachusetts Medical School, Worcester, Massachusetts.
J Urol. 2022 Sep;208(3):650-657. doi: 10.1097/JU.0000000000002750. Epub 2022 Jun 2.
The treatment of stones ureteroscopically is associated with postoperative pain, thought to be due largely to the use of ureteral stents. In some, stent removal precipitates renal colic that can last from minutes to hours. We sought to determine if intramuscular ketorolac could reduce post-stent removal renal colic.
We performed a prospective, randomized, double-blind, placebo-controlled trial assessing the effects of ketorolac administered at time of stent removal. Patients were randomized to receive an intramuscular ketorolac 30 mg or placebo immediately prior to stent removal. Patients were contacted 1 and 7 days after stent removal to assess pain, need for opioids, emergency department or clinic visits and the need for surgical/medical interventions.
A total of 124 patients (62 patients each in the control and treatment groups) were included in the study. The groups were comparable in demographic/operative characteristics. No difference in mean pain scores or proportion of patients who experienced severe pain at 1 and 7 days post stent removal was detected between groups. However, use of ketorolac resulted in significantly fewer renal colic-related unplanned emergency department/clinic visits in the treatment group (2%) compared with the control group (13%, p=0.032).
Although administration of ketorolac prior to stent removal does not significantly reduce overall subjective pain experienced post stent removal compared to placebo, it does reduce the likelihood of severe renal colic requiring emergency department or office visits. Eligible patients may benefit from routine use of ketorolac injection at the time of stent removal.
经输尿管镜治疗结石与术后疼痛相关，其原因主要与输尿管支架的使用有关。在某些情况下，支架取出会引发肾绞痛，持续时间从几分钟到几小时不等。我们试图确定肌肉内注射酮咯酸是否可以减少支架取出后的肾绞痛。
我们进行了一项前瞻性、随机、双盲、安慰剂对照试验，评估了在支架取出时给予酮咯酸的效果。患者随机接受肌肉内注射酮咯酸 30mg 或安慰剂，在支架取出前即刻给药。在支架取出后 1 天和 7 天，通过联系患者来评估疼痛、对阿片类药物的需求、急诊或诊所就诊情况以及手术/医疗干预的需求。
共有 124 名患者（每组 62 名患者）纳入研究。两组在人口统计学/手术特征方面具有可比性。支架取出后 1 天和 7 天，两组的平均疼痛评分或经历严重疼痛的患者比例均无差异。然而，与对照组（13%）相比，治疗组（2%）因肾绞痛相关而计划外急诊/诊所就诊的次数明显减少（p=0.032）。
尽管与安慰剂相比，支架取出前给予酮咯酸并没有显著降低支架取出后总体主观疼痛的程度，但它确实降低了需要急诊或就诊的严重肾绞痛的可能性。有资格的患者可能受益于在支架取出时常规使用酮咯酸注射。
