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• W2055065362 abstract "No AccessJournal of UrologyAdult Urology: Infection/Inflammation1 Aug 2005IS THERE A ROLE FOR ANTIMUSCARINICS IN RENAL COLIC? A RANDOMIZED CONTROLLED TRIAL ANNA HOLDGATE and CARISSA M. OH ANNA HOLDGATEANNA HOLDGATE More articles by this author and CARISSA M. OHCARISSA M. OH More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000165337.37317.4cAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We determined whether the addition of hyoscine butylbromide (Buscopan™) reduces the amount of opioid analgesia required and the need for ongoing opioid analgesia in acute renal colic. Materials and Methods: Patients with a clinical diagnosis of acute renal colic were prospectively randomized to receive Buscopan™ or placebo in addition to morphine and intravenous fluids, with or without indomethacin. Observations and pain scores were recorded 15 every minutes during the first hour then hourly thereafter. Morphine was administered in 2.5 mg increments until pain relief was achieved. Recordings were ceased at 4 hours or on discharge from the emergency department, whichever occurred first. The diagnosis of renal colic was confirmed by computerized tomography. The dose of morphine (mg/kg) and the proportion of patients who required further morphine were compared between the 2 groups. Results: Of the 192 patients randomized, data were available for 178 on an intent to treat basis. A total of 85 patients received Buscopan™ while 93 received placebo in addition to standard therapy. Patients in the Buscopan™ group required a median of 0.12 mg/kg of morphine while those in the placebo group received a median of 0.11 mg/kg, and this difference was not significant (p =0.4). There was also no significant difference in the proportion of patients who required additional morphine, 33% in the Buscopan™ group and 38% in the placebo group (p =0.5). Subgroup analysis of the 138 patients with a confirmed stone also showed no difference between the groups. Conclusions: There is no evidence that Buscopan™ reduces opioid requirements or the need for ongoing opioid analgesia in acute renal colic. References 1 : Nephrolithiasis. Emerg Med Clin North Am1988; 6: 617. Google Scholar 2 : Urinary lithiasis: etiology, diagnosis and medical management. In: . Philadelphia: W. B. Saunders Co.2002: 3229. sect. XII, chapt. 96. Google Scholar 3 : Urologic stone disease. In: Emergency Medicine: A Comprehensive Study Guide,. Edited by . New York: McGraw-Hill2004: 620. chapt. 96. Google Scholar 4 : Renal colic. In: Textbook of Adult Emergency Medicine. Edited by . Edinburgh: Churchill Livingstone2000: 372. chapt. 9.3. Google Scholar 5 : Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic. BMJ2004; 328: 1401. Google Scholar 6 : Renal/Urology. In: The Emergency Medicine Manual. Edited by . West Beach: Venom Publishing2000: 437. Google Scholar 7 : Urological trauma and emergencies. In: Emergency Medicine: The Principles of Practice. Edited by . Sydney: Churchill Livingstone2004: 206. chapt. 19. Google Scholar 8 : Intravenous tenoxicam to treat acute renal colic: comparison with Buscopan™ compositum. J Pakistan Med Assoc1998; 48: 370. Google Scholar 9 : Sublingual hyoscyamine sulfate in combination with ketorolac tromethamine for ureteral colic: a randomized, double-blind, controlled trial. Ann Emerg Med2001; 37: 141. Google Scholar 10 : The efficacy of sublingual hyoscamine sulfate and intravenous ketorolac tromethamine in the relief of ureteral colic. Am J Emerg Med1998; 16: 557. Google Scholar 11 : How accurate are emergency clinicians at interpreting noncontrast computed tomography for suspected renal colic?. Acad Emerg Med2003; 10: 315. Google Scholar 12 : Double-blind study with dipyrone versus tramadol and butylscopolamine in acute renal colic pain. World J Urol1994; 12: 155. Google Scholar 13 : Comparative study of Baralgan and hyoscine-N-methyl bromide in the treatment of intestinal and renal colicy pain. J Med Assoc Thai1986; 69: 569. Google Scholar 14 : Are there valid reasons for using anti-muscarinc drugs in the management of renal colic?. Br J Urol1985; 57: 498. Google Scholar 1 : Conventional and alternative methods for providing analgesia in renal colic. BJU Int2005; 95: 297. Google Scholar 2 : Clinical practice. Acute renal colic from ureteral calculus. N Engl J Med2004; 350: 684. Google Scholar 3 : Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol2003; 170: 2202. Link, Google Scholar 4 : Nifedipine for the relief of renal colic: a double-blind, placebo-controlled clinical trial. Ann Emerg Med1989; 18: 352. Google Scholar 5 : The effectiveness of tenoxicam versus isosorbide dinitrate plus tenoxicam in the treatment of acute renal colic. BJU Int2000; 85: 783. Google Scholar 6 : Local active warming: an effective treatment for pain, anxiety and nausea caused by renal colic. J Urol2003; 170: 741. Abstract, Google Scholar 7 : Acupuncture in the treatment of renal colic. J Urol1992; 147: 16. Abstract, Google Scholar Department of Emergency Medicine, St. George Hospital, Sydney, Australia© 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 174Issue 2August 2005Page: 572-575 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.Keywordsmuscarinic antagonistsbutylscopolammonium bromidekidneycalculicolicMetricsAuthor Information ANNA HOLDGATE More articles by this author CARISSA M. OH More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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