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.
  • 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.
  • Javad Seyedhosseini Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Keywords: Emergency service, hospital, Nitroglycerin, Pain management, Renal colic


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.


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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.
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.
Original article

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