Pain Relieving Effect of Sublingual Glycerol Trinitrate in Renal Colic: a Randomized Placebo-Controlled Trial

  • Leyla Nasehi Department of Radiology, Cleveland Clinic Foundation; OH, USA. http://orcid.org/0000-0001-6496-0316
  • Reza Taslimi Department of Gastroenterology, Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
  • Ahmadreza Dehpour Department of Pharmacology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. http://orcid.org/0000-0002-8001-5565
  • Javad Seyedhosseini Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences http://orcid.org/0000-0002-9131-9732
Keywords: Emergency service, hospital, Nitroglycerin, Pain management, Renal colic

Abstract

Introduction: Renal colic is caused by colicky spasms of ureters. As has been shown in previous experiments, glycerol trinitrate (TNG) can inhibit these muscular spasms. Objective: This study was performed to assess the pain relieving effect of TNG among patients referred due to renal colic pain to the emergency department (ED). Methods: This study is a randomized, placebo-controlled study on 60 patients with renal colic who were referred to the ED, who were diagnosed clinically to have renal colic, and their pain was more than 5 based on a visual analogue scale (VAS). The patient's pain was recorded at the moment of clinical diagnosis, and each one received one capsule, either 0.4 mg TNG or placebo, plus a 100 mg indomethacin suppository. The pain score was re-assessed after 5 and 30 min. The values were recorded and compared using SPSS-16 software. Results: Sixty patients with a mean age of 35.75 ± 11.99 years were enrolled (73.3% male). Patients in the two groups were matched for age (p = 0.290), sex (p = 0.559), and the presence of microscopic hematuria (p = 0.292). Pain relief from the start point until the end of the intervention was statistical different in all studied patients (p < 0.05); but the comparison between the two groups showed no significant difference in this regard (p = 0.440). Conclusion: It is likely that adding TNG to an indomethacin suppository had no significant effects on better pain management of patients referred with renal colic to the ED.

References

1. Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol. 2010;12(2-3):e86.
2. Bartoletti R, Cai T, Mondaini N, Melone F, Travaglini F, Carini M, et al. Epidemiology and risk factors in urolithiasis. Urol Int. 2007;79(Suppl. 1):3-7.
3. Masarani M, Dinneen M. Ureteric colic: new trends in diagnosis and treatment. Postgrad Med J. 2007;83(981):469-72.
4. York NE, Borofsky MS, Lingeman JE. Risks associated with drug treatments for kidney stones. Expert Opin Drug Saf. 2015;14(12):1865-77.
5. Miller NL, Lingeman JE. Management of kidney stones. BMJ. 2007;334(7591):468–72.
6. Arhami-Dolatabadi A, Memary E, Kariman H, Nasiri-Gigloo K, Baratloo A. Intranasal Desmopressin Compared with Intravenous Ketorolac for Pain Management of Patients with Renal Colic Referring to the Emergency Department: A Randomized Clinical Trial. Anesth Pain Med. 2017;7(2):e43595.
7. Sevinsky R, Stewart D, Harirforoosh S. Nonsteroidal anti-inflammatory drugs: Is there a link between cardiovascular and renal adverse effects? J Integr Nephrol Androl. 2017;4(1):1-2.
8. Berde C, Nurko S. Opioid Side Effects — Mechanism-Based Therapy. N Engl J Med. 2008;358(22):2400-2.
9. Connolly C, Tierney S, Grace P. Systemic glyceryl trinitrate reduces anal sphincter tone: is there a therapeutic indication? Ir J Med Sci. 2017:1-6.
10. Hill P-A, Panteleimonitis S, McKay G, Watson C, Prach A, Macdonald A. Sublingual glyceryl trinitrate during colonoscopy and terminal ileal intubation: a randomized controlled trial. Scott Med J. 2017;62(1):11-5.
11. Golzari S, Soleimanpour H, Rahmani F, Safari S, Heshmat Y. Therapeutic approaches for renal colic in the emergency department: a review article. Anesth Pain Med. 2014;4(1):e16222.
12. Kaffes AJ, Bourke MJ, Ding S, Alrubaie A, Kwan V, Williams SJ. A prospective, randomized, placebo-controlled trial of transdermal glyceryl trinitrate in ERCP: effects on technical success and post-ERCP pancreatitis. Gastrointest Endosc. 2006;64(3):351-7.
13. Talwar A, Dare C, Pain J. Does topical GTN on the sphincter of Oddi facilitate ERCP? A double-blind randomized control trial. Surg Endosc. 2005;19(7):902-4.
14. Armstrong P, Armstrong J, Marks G. Blood levels after sublingual nitroglycerin. Circulation. 1979;59(3):585-8.
15. Dubinsky I, Penciner R. Nitroglycerin and renal colic. Ann Emerg Med. 1997;29(6):824-5.
16. Hofstetter A, Kriegmair M. Treatment of ureteral colic with glycerol trinitrate. Fortschr Med. 1993;111(16):286-8.
17. Razi A, Zargoosh J. Effect of sublingual nitroglycerine on pain relief in renal and ureteral colic. Med J IR Iran. 1997;11(2):103-4.
Published
2017-12-04
How to Cite
Nasehi, L., Taslimi, R., Dehpour, A., & Seyedhosseini, J. (2017). Pain Relieving Effect of Sublingual Glycerol Trinitrate in Renal Colic: a Randomized Placebo-Controlled Trial. Advanced Journal of Emergency Medicine, 2(1), e2. https://doi.org/10.22114/ajem.v0i0.3
Section
Original article