medigraphic.com

2017, Number S1

<< Back Next >>

Rev Med Inst Mex Seguro Soc 2017; 55 (S1)

Management of ureteric colic with ketorolac and nifedipin vs. ketorolac and tamsulosin in the emergency room

Montiel-Jarquín ÁJ, Rocha-Rocha VM, Solís-Mendoza HA, Romero-Figueroa MS, Etchegaray-Morales I, Alvarado-Ortega I

Language: Spanish
References: 20
Page: 20-25
PDF size: 281.31 Kb.


ABSTRACT

Background: Ureteric colic is the most common symptom of lithiasis. It is caused by the presence of stones accumulated in the renal papillae. These stones often migrate down the ureter, causing a ureteric colic, characterized by a severe pain in the lumbar region. The aim of this study was to compare the use of ketorolac and nifedipine vs. ketorolac and tamsulosin for the medical treatment of pain caused by stones in the lower ureter.
Methods: Longitudinal study of 150 patients of 21-years or older with stones in the lower third of the ureter. 50% received ketorolac and nifedipine and the other 50%, ketorolac and tamsulosin. The Numeric Pain Rating Scale (NPRS) was used for the assessment of pain at admission and 4 and 12 hours after the treatment was administered. We used descriptive and inferential statistics (Mann-Whitney-Wilcoxon, chisquared and Poisson regression).
Results: Mean age was 38.17 years; 54.7% were male and 45.3% female. NPRS mean was 9.69 (initially), 7.42 (at 4 hours) and 2.05 (at 12 hours). There were no significant differences in the initial measurement of pain between groups (p ‹ 0.005); four and 12 hours later the pain decreased more in patients managed with ketorolac and nifedipine, p = 0.0041. There were no complications nor side effects in both treatments.
Conclusion: The use of ketorolac and nifedipine is more effective than the use of ketorolac and tamsulosin for the management of pain caused by lower ureteral colic during the first 12 hours of treatment.


REFERENCES

  1. Milián-Partida AP. Eficacia del Nifedipino vs Tratamiento conservador en el manejo de pacientes con cólico renoureteral en el servicio de urgencias [tesis de especialidad en Urgencias Médicas]. Puebla, México: Benemérita Universidad Autónoma de Puebla-Instituto Mexicano del Seguro Social; 2009.

  2. Berger DA, Ross MA, Hollander JB, Ziadeh J, Chen C, Jackson RE, et al. Tamsulosin does not increase 1-week passage rate of ureteral stones in ED patients. Am J Emerg Med. 2015;33:1721-4.

  3. Furyk JS, Chu K, Banks C, Greenslade J, Keijzers G, Thom O, et al. Distal Ureteric Stones and Tamsulosin: A Double Blind, Placebo-Controlled, Randomized, Multicenter Trial. Ann Emerg Med. 2016; 67(1):86- 95.e2. doi:10.1016/j.annemergmed.2015.06.001.

  4. Soderman TW, Alvarado BJ. Litiasis renal y ureteral. Guías de práctica clínica basadas en evidencia. Proyectos ISSI-Ascofame. 2002;21-40.

  5. Maldonado-Ávila M, Enríquez-Lemus J, Castellanos- Lizárraga J, Gutiérrez-Godínez FA, Garduño- Arteaga L, Castell-Cancino R et al. Estudio comparativo de la eficacia de tamsulosina vs nifedipina para la expulsión de litos ureterales de tercio inferior. Rev Mex Urol. 2006;66(2):83-7.

  6. Preminfinger GM, Tiselius HG, Assimos DG, Alken P, Buck C, Gallucci M, et al. 2007. 2007 guideline for the management of ureteral calculi. J Urol. 2007 Dec;178(6):2418-34.

  7. Porpiglia F, Ghignone G, Fiori C, Fontana D, Scarpa RM. Nifedipine versus tamsulosin for de management of lower ureteral stone. J Urol. 2004;172(2): 568-71.

  8. Goodman G, Goodman LS, Gilman A. Bloqueadores de los canales de calcio. En: Bases farmacológicas de la terapéutica. Octava edición. México, DF: McGraw-Hill, 1996. pp. 826-30.

  9. Dellabella M, Milanese G, Muzzonigro G. Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol. 2003 Dec;170(6 Pt 1):2202-5.

  10. Seitz C, Liatsikos E, Porpiglia F, Tiselius HG, Zwergel U. Medical Therapy to Facilitate the Passage of Stones: What Is the Evidence? Eur Urol. 2009;56(3):455-71.

  11. Naja V, Agarwal MM, Mandal AK, Singh SK, Mavuduru R, Kumar S, et. al. Tamsulosin facilitates earlier clearance of stone fragments and reduces pain after shockwave lithotripsy for renal calculi; results from an open-label randomized study. Urology. 2008 Nov;72(5):1006-11.

  12. Cao D, Yang L, Liu L, Yuan H, Qian S, Lv X, et al. A comparison of nifedipine and tamsulosin as medical expulsive therapy for the management of lower ureteral stones without ESWL. Sci Rep. 2014;4:5254.

  13. Seitz C. Medical Expulsive Therapy of Ureteral Calculi and Supportive Therapy After Extracorporeal Shock Wave Lithotripsy. Europ Urol Suppl. 2010;9: 807.813.

  14. Hermida-Pérez JA, Pérez-Palmes MP, Loro-Ferrer JF, Ochoa-Urdangarain O, Buduen-Nuñez A. Cólico nefrítico en el servicio de urgencias. Estudio epidemiológico, diagnóstico y etiopatogénico. Arch Esp Urol. 2010;63(3):173-187.

  15. Martínez-Pérez R. Revisión del tratamiento farmacológico de la urolitiasis. FAP. 2012;10(1):18-24.

  16. Holst P. Cólico renal. Rev Arg Urol. 2004;69(3): 172-86.

  17. Gállego-Sales S, Martínez-Valles MA. Manejo de la litiasis ureteral distal con deflazacort y nifedipina. Rev Mex Urol. 2005;65(4):264-8.

  18. Ye Z, Yang H, Li H, Zhang X, Deng Y, Zeng G, et al. A multicenter, prospective, randomized trial: comparative efficacy of tamsulin and nifedipine in medical expulsive therapy for distal ureteric stones with renal colic. BJU Int. 2011 Jul;108(2):276-9.

  19. Carvati EM, Runge JW, Bossart PJ, Martínez JC, Hartsell SC, Williamson SG. Nifedipine for the relief of renal colic: a double-blind, placebo controlled clinical trial. Ann Emerg Med. 1989;18(4):352-54.

  20. McClinton S, Starr K, Thomas R, McLennan G, McPherson G, McDonald A, et al. Use of drug therapy in the management of symptomatic ureteric stones in hospitalized adults (SUSPEND), a multicentre, placebo-controlled, randomized trial of calcium-channel blocker (nifedipine) and an α-blocker (tamsulin): study protocol for a randomized controlled trial. Trials. 2014 Jun 20;15:238. doi: 10.1186/1745-6215-15-238.




2020     |     www.medigraphic.com