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Original Article

Korean J Pain 2019; 32(2): 97-104

Published online April 1, 2019 https://doi.org/10.3344/kjp.2019.32.2.97

Copyright © The Korean Pain Society.

Low-dose intravenous ketamine versus intravenous ketorolac in pain control in patients with acute renal colic in an emergency setting: a double-blind randomized clinical trial

Mehran Sotoodehnia, Mozhgan Farmahini-Farahani, Arash Safaie, Fatemeh Rasooli, and Alireza Baratloo

Prehospital Emergency Research Center and Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

Correspondence to:Mozhgan Farmahini-Farahani, Department of Emergency Medicine, Sina Hospital, Hasanabad Square, Tehran 1136746911, Iran
Tel: +98-91-2680-6154, Fax: +98-21-6312-1432, E-mail: farahanimozhgan@yahoo.com, ORCID: https://orcid.org/0000-0001-7529-6617

Received: December 18, 2018; Revised: January 16, 2019; Accepted: January 23, 2019

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: This study was conducted to compare the effectiveness of low-dose ketamine versus ketorolac in pain control in patients with acute renal colic presenting to the emergency department (ED).
Methods: This is a double-blind randomized clinical trial. The initial pain severity was assessed using the numerical rating scale (NRS). Then, ketamine or ketorolac was administered intravenously at a dose of 0.6 mg/kg and 30 mg respectively. The pain severity and adverse drug reactions were recorded 5, 15, 30, 60, and 120 min thereafter.
Results: The data of 62 subjects in the ketamine group and 64 patients in the ketorolac group were analyzed. The mean age of the patients was 34.2 ± 9.9 and 37.9 ± 10.6 years in the ketamine and ketorolac group, respectively. There was no significant difference in the mean NRS scores at each time point, except for the 5 min, between the two groups. Despite a marked decrease in pain severity in the ketamine group from drug administration at the 5 min, a slight increase in pain was observed from the 5 min to the 15 min. The rate of adverse drug reactions, including dizziness (P = 0.001), agitation (P = 0.002), increased systolic blood pressure (> 140 mmHg), and diastolic blood pressure (> 90 mmHg) was higher in the ketamine group.
Conclusions: Low dose ketamine is as effective as ketorolac in pain management in patients with renal colic presenting to the ED. However, it is associated with a higher rate of adverse drug reactions.

Keywords: Acute pain, Blood pressure, Double-blind method, Drug-related adverse reactions, Hospital emergency service, Ketamine, Ketorolac, Pain management, Randomized controlled trial, Renal colic, Urinary calculi.