Comparison of Intranasal Ketamine and Intranasal Fentanyl as Adjuncts to Intravenous Ketorolac for Pain Relief in Renal Colic: A Randomized Clinical Trial - Abstract
Background: Pain relief in patients with renal colic is a crucial aspect of emergency department (ED) management. Current analgesic options, such as opioids and nonsteroidal anti-inflammatory drugs (NSAIDs), are associated with various side effects and contraindications. This study aimed to investigate and compare the efficacy of intranasal ketamine/intravenous ketorolac and intranasal fentanyl/intravenous ketorolac combinations with intravenous ketorolac monotherapy in reducing pain among patients with renal colic. Materials and Methods: This double-blind randomized clinical trial enrolled 120 patients with renal colic who met the inclusion and exclusion criteria. Participants were randomly assigned to three groups: Group A received 1 mg/kg intranasal ketamine and 30 mg intravenous ketorolac, Group B received 1.5 µg/kg intranasal fentanyl and 30 mg intravenous ketorolac, and Group C received only 30 mg intravenous ketorolac and nasal placebo. Vital signs, adverse effects, and pain intensity based on the visual analog scale (VAS) score were recorded at specified intervals. Results: There were no significant differences in demographic variables and mean initial pain intensity among the groups. Following the intervention, both the ketamine/ketorolac and fentanyl/ketorolac groups exhibited faster pain reduction compared to the ketorolac group. However, there was no significant difference between the two combination drug regimens (P Value = 0.044, 0.906). The ketamine/ketorolac group demonstrated a quicker response to treatment compared to the other two groups (P Value = 0.004). Some side effects were more frequently reported in the combination drug group than in the single drug group. Conclusion: The combined regimens of ketamine/ketorolac and fentanyl/ketorolac appear to provide faster pain control in patients with renal colic compared to the single-drug regimen of ketorolac, without increasing the risk of serious complications.