Intranasal Ketamine Versus Intravenous Ketorolac for Pain Control in the Renal Colic: A Randomized Clinical Trial Study

Abstract

Background: Renal colic is one of the most common complaints among patients referring to the emergency department (ED). Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are gold standards to relieve pain. Objectives: The aim of this study was to evaluate the effects of intranasal Ketamine on pain control versus Ketorolac. Methods: In this randomized clinical trial (RCT), the patients were randomly assigned into two groups. While Ketorolac 30 mg was given intravenously to all patients in the control group, the patients in intervention group received 1 mg/kg drops of Ketamine intranasally. Pain severity, vital signs, and adverse events (AEs) were recorded after 60 min post-dose. Results: A total of 100 patients were enrolled in this study. The mean visual analog scale (VAS) score after the first 5 min was lower in the intranasal Ketamine group compared to control (5 ± 2.26 vs. 8.62 ± 0.49, respectively; P < 0.001), which remained significant at the end of 60th min (P < 0.001). Moreover, additional analgesics administration was higher in intravenous Ketorolac than intranasal Ketamine (22 vs 0%), which was significantly different (P = 0.001). Patients' satisfaction was higher in the intranasal Ketamine group compared to control (3.56 ± 0.35 vs. 1.82 ± 0.98, respectively; P < 0.001). Conclusions: Intranasal Ketamine was beneficial in controlling renal colic-induced pain, which could be prescribed as a treatment instead of normal treatment. It can rapidly improve pain relief in the short term, has lower AEs, and increases the patients' satisfaction.