Intradermal sterile water may achieve pain relief in patients with severe renal colic

Kidney stone disease is a common debilitating condition which is diagnosed using computed tomography (CT). The guidelines aim to decrease radiation exposure to patients by minimizing the use of CT scans and X-rays. Renal colic is a very painful condition that affects about 12% of the population and causes 1.2 million to seek care in several healthcare facilities each year; accounting for 1% of all hospital admissions and 1% of all Emergency Department (ED) visits.

Recurrence rates approach nearly 50% after 10 years in 50% of people with a history of kidney stones. Renal colic pain is multifactorial and is related to the obstruction of urinary flow with a subsequent increase in intra-ureteral and intra-renal pressure and prostaglandins-mediated ureteral spasm.

Considering the importance of a fast and effective treatment for renal colic pain patients in the emergency department for both clinicians' patient management and patients' comfort, Rohat Ak, Kartal Dr Lütfi Kırdar City Hospital, Kartal, Istanbul, Turkey, and colleagues primarily aimed to test the efficacy of intradermal sterile water application as an effective and rapid treatment in severe renal colic.

For this purpose, the researchers conducted a prospective, single-centre, randomized controlled trial consisting of patients with severe renal colic related to urolithiasis. 95 out of 201 patients with severe renal colic pain were randomly divided into 3 groups. The first group received only intramuscular diclofenac sodium, the second group received intramuscular diclofenac sodium and intradermal sterile water, and the third group received intramuscular diclofenac sodium and intravenous fentanyl. The level of pain before and after the treatment was determined using the Numerical Rating Scale at the 1st, 5th, 15th, 30th, 60th and 120th minutes.

Based on the study, the researchers reported the following findings:

• The pre-treatment pain severity of the groups was similar.
• The decrease in pain intensity was significantly faster in the intradermal sterile water group than in the other groups even in the first minute.
• Percentages of patients who had 50% pain reduction, which is considered a successful treatment, was higher in the intradermal sterile water group (which had 75.9% success rate) in the first 5 min compared to the IM diclofenac sodium group (which had 7.1% success rate) and IV fentanyl group (which had 25% success rate).

"The findings showed that the pain control was achieved much faster than the other methods with intradermal sterile water injection," the researchers wrote. "All methods were found to be effective in pain relief of the patients."

Reference:

Aykanat, M.C., Kılıç, M., Cimilli Öztürk, T. et al. The efficacy of intradermal sterile water application in severe renal colic: a randomised clinical trial. Urolithiasis 51, 121 (2023). https://doi.org/10.1007/s00240-023-01496-6