Sukhram Shiryn D, Yilmaz Grozdena, Erichsen Stephanie, Vassilevich Sergey
Biology Department, College of Staten Island, City University of New York, Staten Island, NY 10314, USA.
Nursing Department, College of Staten Island, City University of New York, Staten Island, NY 10314, USA.
Int J Mol Sci. 2025 Jan 4;26(1):371. doi: 10.3390/ijms26010371.
Kidney stones typically present as renal colic in emergency departments (EDs), where patients experience severe pain and often require parenteral therapy for symptom management. The economic burden associated with managing kidney stones exceeds USD 5 billion annually in the US and accounts for more than a million visits to EDs each year. There is clear evidence emphasizing the need for innovative and alternative pain control options for patients with renal colic. Recent randomized controlled trials suggest that intranasal (IN) and intravenous (IV) ketamine are as effective as parenteral NSAIDs and opioids in treating renal colic. However, the limited studies available show inconsistent results regarding the analgesic effects of ketamine. In this study, we reviewed the mechanism of action of ketamine for kidney stones, its efficacy in treating acute renal colic, and the potential adverse side effects of ketamine treatment. A population, intervention, comparison, and outcome (PICO)-related question was formulated to guide our research inquiry: "What are the effects of IV or IN ketamine, as a single agent or as an adjuvant (I), in adult patients diagnosed with acute renal colic (P) on pain scale scores and adverse side effects (O) compared to NSAIDs and/or opioids (C)?"
肾结石在急诊科通常表现为肾绞痛，患者会经历剧痛，且往往需要接受肠外治疗来控制症状。在美国，每年与肾结石治疗相关的经济负担超过50亿美元，每年有超过100万人次前往急诊科就诊。有明确证据表明，需要为肾绞痛患者提供创新的、替代性的疼痛控制方案。最近的随机对照试验表明，鼻内（IN）和静脉内（IV）注射氯胺酮在治疗肾绞痛方面与肠外非甾体抗炎药和阿片类药物一样有效。然而，现有的有限研究在氯胺酮的镇痛效果方面显示出不一致的结果。在本研究中，我们回顾了氯胺酮治疗肾结石的作用机制、其治疗急性肾绞痛的疗效以及氯胺酮治疗的潜在不良反应。我们制定了一个与人群、干预措施、对照和结局（PICO）相关的问题，以指导我们的研究探索：“与非甾体抗炎药和/或阿片类药物（C）相比，静脉注射或鼻内注射氯胺酮作为单一药物或辅助药物（I），对诊断为急性肾绞痛的成年患者（P）的疼痛量表评分和不良反应（O）有何影响？”
