Introduction: Renal colic affects 12% of the U.S. population, accounting for nearly 1% of emergency department (ED) visits. Current recommendations advocate narcotic-limiting multimodal analgesia regimens. The objective of this review is to determine if in patients with renal colic (Population), intravenous (IV) amide anesthetics (Intervention) result in better pain control, lower requirements for rescue analgesia, or less adverse medication effects (outcome) compared to placebo, non-steroidal anti-inflammatory drugs (NSAIDs), or opiates (Comparisons).
Methods: Scholarly databases and relevant bibliographies were searched using a pre-designed systematic review protocol and registered with PROSPERO. Inclusion criteria were: (1) randomized clinical trial (RCT), (2) age ≥ 18 years, (3) confirmed or presumed renal colic, (4) amide anesthetic administered IV. Eligible comparison groups included: placebo, conventional therapy, acetaminophen, NSAID, or opiate. The primary outcome was pain intensity at baseline, 30, 60, and 120 minutes. Trial quality was graded, and risk-of-bias was assessed.
Results: Of the 3930 identified references, 4 RCTs (479 participants) were included. One trial (n=240) reported improved analgesia with IV lidocaine (LidoIV) plus metoclopramide, compared to morphine. All other trials reported unchanged or less analgesia compared to placebo, ketorolac, or fentanyl. Very severe heterogeneity (I2= 88%) precluded pooling data.
Conclusion: Current evidence precludes drawing a firm conclusion on the efficacy or superiority of LidoIV over traditional therapies for ED patients with renal colic. Evidence suggests LidoIV may be an effective non-opiate analgesic alliterative; however, it’s efficacy may not exceed that of NSAIDs or opiates. Further study is needed to validate the potential improved efficacy of LidoIV plus metoclopramide.
e Silva LOJ, Scherber K, Cabrera D, Motov S, Erwin PJ, West CP, et al. Safety and efficacy of intravenous lidocaine for pain management in the emergency department: A systematic review. Ann Emerg Med. 2018 Aug; 72 (2):135-144.e3.
Liu J. Comparative observation of analgesic effect of dizocine and diclofenac lidocaine combined with progesterone in the treatment of acute renal colic ureterolithiasis. J Clin Ration Drug Use. 2016; 28:24–5. [Chinese].
Motov S, Drapkin J, Butt M, Monfort R, Likourezos A, Marshall J. Pain management of renal colic in the emergency department with intravenous lidocaine. Am J Emerg Med. 2018; 36 (10):1862–4.
Ghani KR, Roghmann F, Sammon JD, Trudeau V, Sukumar S, Rahbar H, et al. Emergency department visits in the United States for upper urinary tract stones: trends in hospitalization and charges. J Urol. 2014; 191 (1):90–6.
Brown J. Diagnostic and treatment patterns for renal colic in US emergency departments. Int Urol Nephrol. 2006; 38 (1):87–92.
Golzari SE, Soleimanpour H, Rahmani F, Zamani Mehr N, Safari S, Heshmat Y, et al. Therapeutic approaches for renal colic in the emergency department: a review article. Anesthesiol Pain Med . 2014; 4 (1):e16222.
Holdgate A, Pollock T. Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic. BMJ. 2004; 328 (7453):1401.
Motov S, Fassassi C, Drapkin J, Butt M, Hossain R, Likourezos A, et al. Comparison of intravenous lidocaine/ketorolac combination to either analgesic alone for suspected renal colic pain in the ED. Am J Emerg Med. 2019; S0735-6757(19)30070-1. [In Press].
Day RO, Graham GG. Non-steroidal anti-inflammatory drugs (NSAIDs). BMJ. 2013; 346:f3195.
Hoppe JA, Nelson LS, Perrone J, Weiner SG, Prescribing Opioids Safely in the Emergency Department (POSED) Study Investigators. Opioid prescribing in a cross section of US emergency departments. Ann Emerg Med. 2015; 66 (3):253-259.e1.
Jones MR, Viswanath O, Peck J, Kaye AD, Gill JS, Simopoulos TT. A brief history of the opioid epidemic and strategies for pain medicine. Pain Ther. 2018; 7 (1):13–21.
Miller AC, Khan AM, Castro Bigalli AA, Sewell KA, King AR, Ghadermarzi S, et al. Neuroleptanalgesia for acute abdominal pain: a systematic review. J Pain Res. 2019; 12:787–801.
Weinberg L. Pharmacokinetics and pharmacodynamics of lignocaine: A review. World J Anesthesiol. 2015; 4 (2):17.
Koppert W, Zeck S, Sittl R, Likar R, Knoll R, Schmelz M. Low-dose lidocaine suppresses experimentally induced hyperalgesia in humans. Anesthesiology. 1998; 89 (6):1345–53.
Beaussier M, Delbos A, Maurice-Szamburski A, Ecoffey C, Mercadal L. Perioperative use of intravenous lidocaine. Drugs. 2018; 78 (12):1229–46.
Hosseininejad SM. Can the addition of low dose lidocaine improve the effectiveness of narcotics in reducing renal colic pain? Am J Emerg Med. 2018; 36 (4):721–2.
Makhoul T, Kelly G, Schult RF, Acquisto NM. Intravenous lidocaine for renal colic in the emergency department (ED). Am J Emerg Med. 2019; 37 (4):775.
Firouzian A, Alipour A, Rashidian Dezfouli H, Zamani Kiasari A, Gholipour Baradari A, Emami Zeydi A, et al. Does lidocaine as an adjuvant to morphine improve pain relief in patients presenting to the ED with acute renal colic? A double-blind, randomized controlled trial. Am J Emerg Med. 2016; 34 (3):443–8.
Motamed H, Maleki Verki M. Intravenous lidocaine compared to fentanyl in renal colic pain management; A randomized clinical trial. Emergency. 2017; 5 (1):e82.
Soleimanpour H, Hassanzadeh K, Vaezi H, Golzari SEJ, Esfanjani RM, Soleimanpour M. Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department. BMC Urol. 2012; 12:13.
Gani H, Hoxha B, Xhani R, Dredha H, Karamitri G, Lenjani B, et al. Comparison of intravenous lidocaine versus intravenous morphine for patients with renal colic. Eur Urol Suppl. 2016; 15 (10):e1285.
Drapkin J, Motov S, Likourezos A, Monfort R, Butt M, Hossain R, et al. A randomized trial comparing the combination of intravenous lidocaine and ketorolac to either analgesics alone for emergency department patients with acute renal colic. Ann Emerg Med. 2018; 72 (Suppl):S1.
Sin B, Effendi M, Bjork C, Punnapuza S. The use of intravenous lidocaine for renal colic in the emergency department. Ann Pharmacother. 2016; 50 (3):242.
Sin B, Cao J, Yang D, Ambert K, Punnapuzha S. Intravenous lidocaine for intractable renal colic unresponsive to Standard therapy. Am J Ther. 2019; 26 (4):e487–8.
Soleimanpour H, Hassanzadeh K, Mohammadi DA, Vaezi H, Esfanjani RM. Parenteral lidocaine for treatment of intractable renal colic: a case series. J Med Case Rep. 2011; 5:256.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6 (7):e1000097.
Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011; 64 (4):383–94.
Jørgensen L, Paludan-Müller AS, Laursen DRT, Savović J, Boutron I, Sterne JAC, et al. Evaluation of the Cochrane tool for assessing risk of bias in randomized clinical trials: Overview of published comments and analysis of user practice in Cochrane and non-Cochrane reviews. Syst Rev. 2016; 5:80.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997; 315 (7109):629–34.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994; 50 (4):1088–101.
Hedges L V, Pigott TD. The power of statistical tests in meta-analysis. Psychol Methods. 2001; 6 (3):203–17.
Nouira S. Treatment of renal colic in the Emergency Department (ED). Clinicaltrials.gov. 2017 [cited 2019 Jun 16]. Available from: https://clinicaltrials.gov/ct2/show/NCT03199924?term=Treatment+of+Renal+Colic+in+the+Emergency+Departement+%28ED%29&rank=1
Sin BW. Lidocaine vs. ketorolac for management of renal colic in the Emergency Department. Clinicaltrials.gov. 2017 [cited 2019 Jun 19]. Available from: https://clinicaltrials.gov/ct2/show/NCT03137498?term=Treatment+of+Renal+Colic+in+the+Emergency+Departement+%28ED%29&rank=6
Berman DJ, Firlit CF. Effect of metoclopramide on ureteral motility. Urology. 1984; 23 (2):150–6.
Qiwei L, Tan Y, Wengue W, Zhenying W, Chen D, Yongshun D. Metoclopramide vs isosorbide dinitrate in the treatment of renal colic. Shanghai Med Pharm J. 1997; 7:14.
Müller TF, Naesh O, Svare E, Jensen A, Glyngdal P. Metoclopramide (Primperan) in the treatment of ureterolithiasis. A prospective double-blind study of metoclopramide compared with morphatropin on ureteral colic. Urol Int. 1990; 45 (2):112–3.
Kaya FB, Cevik A, Acar N, Kaya S, Zeytin A, Can C, et al. Clinical efficacy of Metoclopramide to treat pain and nausea in renal colic patients: A prospective randomised, double-blind, controlled trial. Hong Kong J Emerg Med. 2015; 22 (2):93–9.
Qiwei L, Tan Y, Wenguo W, Zhenying W, Chen D, Yongshun D. Comparison of the efficacy of metoclopramide and Xintongding in the treatment of renal colic. Shanghai Med J. 1997; 7:23.
Martín Carrasco C, Rodríguez Vázquez M, Palacios Garciá R. A double-blind study of the analgesic efficacy in kidney colic of the combination of dipyrone and spasmolytic with ketorolac trometamol. Arch Esp Urol. 1993; 46 (9):763–8. [Spanish].
O’Connor A, Schug SA, Cardwell H. A comparison of the efficacy and safety of morphine and pethidine as analgesia for suspected renal colic in the emergency setting. J Accid Emerg Med. 2000; 17 (4):261–4.
Safavi M, Honarmand A, Yazdanpanah A. Adding metoclopramide to lidocaine for intravenous regional anesthesia in trauma patients. Adv Biomed Res. 2014; 3:45.
Worster AS, Bhanich Supapol W. Fluids and diuretics for acute ureteric colic. Cochrane Database Syst Rev. 2012; 2:CD004926.
Springhart WP, Marguet CG, Sur RL, Norris RD, Delvecchio FC, Young MD, et al. Forced versus minimal intravenous hydration in the management of acute renal colic: a randomized trial. J Endourol. 2006; 20 (10):713–6.
Nation RL, Triggs EJ, Selig M. Lignocaine kinetics in cardiac patients and aged subjects. Br J Clin Pharmacol. 1977; 4 (4):439–48.
Orlando R, Piccoli P, De Martin S, Padrini R, Palatini P. Effect of the CYP3A4 inhibitor erythromycin on the pharmacokinetics of lignocaine and its pharmacologically active metabolites in subjects with normal and impaired liver function. Br J Clin Pharmacol. 2003; 55 (1):86–93.
Pasero C. Intravenous lidocaine for acute pain treatment. J PeriAnesthesia Nurs. 2011; 26 (3):166–9.
De Martin S, Orlando R, Bertoli M, Pegoraro P, Palatini P. Differential effect of chronic renal failure on the pharmacokinetics of lidocaine in patients receiving and not receiving hemodialysis. Clin Pharmacol Ther. 2006; 80 (6):597–606.
Abernethy DR, Greenblatt DJ. Lidocaine disposition in obesity. Am J Cardiol. 1984; 53 (8):1183–6.