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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

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