Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department

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Abstract

Background

Despite the fact that numerous medications have been introduced to treat renal colic, none has been proven to relieve the pain rapidly and thoroughly. In this study, we aimed at comparing the effects of intravenous lidocaine versus intravenous morphine in patients suffering from renal colic.

Methods

In a prospective randomized double-blind clinical trial performed in the emergency department of Imam Reza educational hospital of Tabriz, Iran, we studied 240 patients, 18–65 years old, who were referred due to renal colic. Patients were divided into two groups. In group I (120 people) single-dose intravenous lidocaine (1.5 mg/kg) was administered and in group II (120 people) single-dose intravenous morphine (0.1 mg/kg) was administered slowly. Visual Analogue Pain Scale (VAS) was recorded while admission, 5, 10, 15 and 30 minutes after injection. Statistical data and results were studied using descriptive statistics as percentage and Mean ± SD. To compare the response to treatment, Mann–Whitney U-test was used in two groups. Consequently, the data were analyzed using the SPSS16 software.

Results

Pain score measured in two groups five minutes after the injection of lidocaine and morphine were 65 % and 53 % respectively (95% CI 0.60 - 0.69, CI 0.48 – 0.57, p = 0.0002).108 (90 %) patients (95 % CI 0.84 – 0.95) from group I and 84 (70%) patients (95 % CI 0.62 - 0.78) from group II responded appropriately at the end of the complete treatment. The difference was statistically significant (p = 0.0001).

Conclusions

Changing the smooth muscle tone and reducing the transmission of afferent sensory pathways, lidocaine causes a significant reduction in pain.

Trial registration

Clinical Trials IRCT138901042496N3

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Most cited references 9

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Systemic lidocaine for neuropathic pain relief.

L. Chen, Jun Mao (2000)

The effectiveness of systemic lidocaine in relieving acute and chronic pain has been recognized for over 35 years. In particular, systemic lidocaine has been utilized both as a diagnostic and therapeutic tool for intractable neuropathic pain during the last decade. The introduction of oral lidocaine congeners such as mexiletine has significantly extended the usage of lidocaine therapy in chronic pain settings. However, a number of clinical issues remain to be addressed including (1) an effective, meaningful dose range for the clinical lidocaine test, (2) the predictive value of the lidocaine test for an oral trial of lidocaine congeners, (3) identification of pain symptoms and signs relieved by systemic lidocaine, (4) comparisons of therapeutic effects between systemic lidocaine and its oral congeners, and (5) long-term outcomes of systemic lidocaine and its oral congeners. Mechanisms of neuropathic pain relief from lidocaine therapy are yet to be understood. Both central and peripheral mechanisms have been postulated. Systemic lidocaine is thought to have its suppressive effects on spontaneous ectopic discharges of the injured nerve without blocking normal nerve conduction. However, there remain inconsistencies in the scientific basis underlying the clinical application of lidocaine therapy. Recent demonstration of changes in tetrodotoxin (TTX)-sensitive and TTX-resistant sodium channels following nerve injury and their link to certain neuropathic pain symptoms may lead to the development of subtype-specific sodium channel blockers. The thoughtful use of lidocaine therapy and the potential application of subtype-specific sodium channel blockers could provide better management of distinctive neuropathic pain symptoms.

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Treatment of postoperative paralytic ileus by intravenous lidocaine infusion.

J Cassuto, P Tollesson, G Rimbäck (1990)

The effects of continuous intravenous infusion of lidocaine on postoperative paralytic ileus in cholecystectomized patients was investigated in this double-blind study. An infusion of lidocaine (3 mg/min, n = 15) or an infusion of an equal volume of saline (n = 15) was started 30 min before induction of anesthesia and continued for 24 h after surgery. Postoperative colonic motility was evaluated by radiopaque markers and serial abdominal radiographs. A record was kept of the first passage of gas and feces. Results showed significantly earlier return of propulsive motility in the colon of lidocaine-treated patients. Radiopaque markers in the lidocaine group were propelled significantly earlier from the cecum/ascending colon to the transverse colon (P less than 0.05) and appeared significantly earlier in the descending colon (P less than 0.05) and the rectosigmoid colon (P less than 0.05) than in saline-treated patients. Despite the fact that the mean time for postoperative defecation occurred 17 h earlier in lidocaine-treated patients, differences between the groups were not statistically significant--a fact due, perhaps, to great individual variations in defecation habits. The time to first passage of gas, a variable representative of changes in anorectal or colonic tone rather than propagative motility, also did not differ significantly between the groups. No adverse reactions to lidocaine were reported. The results suggest that continuous intravenous infusion of lidocaine during the first postoperative day shortens the duration of paralytic ileus in the colon after abdominal surgery. Suppression of inhibitory gastrointestinal reflexes by reduction of postoperative peritoneal irritation is suggested as the mechanism of action.

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Parenteral lidocaine for treatment of intractable renal colic: a case series

Hassan Soleimanpour, Kamaleddin Hassanzadeh, Dawood Agha Mohammadi … (2011)

Introduction We report a case series of successful treatment of intractable renal colic using parenteral lidocaine. Case presentation Because of inconsistent responses to standard treatment with opioids and non-steroidal anti-inflammatory drugs in patients with renal colic pain, we decided to begin a trial of a single intravenous dose of lidocaine (approximately 1.5 mg/kg) slowly in eight patients with intractable renal colic who were referred to our emergency medicine department. The patients were six men and two women with a mean age at diagnosis of 34.62 years (age range, 28 to 42 years). The patients were of Iranian ethnic origin. The patients' degree of pain, based on Visual Analog Scale score upon entering our emergency medicine department, was recorded 10, 20, and 30 minutes after lidocaine injection. The patients' degree of pain decreased from a mean Visual Analog Scale score (±SD) of 8.87 ± 0.99 (95% confidence interval (95% CI) 8.04 to 9.70) to a mean Visual Analog Scale score (±SD) of 1 ± 2.82 (95% CI -1.36 to 3.36) before and 30 minutes after lidocaine treatment, respectively. Two of eight patients experienced transient mild dizziness, and three of eight patients experienced minimal slurring of speech. No patient experienced serious adverse events. Conclusion Parenteral lidocaine treatment can reduce pain dramatically or subtly.

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Author and article information

Journal

Journal ID (nlm-ta): BMC Urol

Journal ID (iso-abbrev): BMC Urol

Title: BMC Urology

Publisher: BioMed Central

ISSN (Electronic): 1471-2490

Publication date Collection: 2012

Publication date (Electronic): 4 May 2012

Volume: 12

Page: 13

Affiliations

[1 ]Emergency Medicine Department, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz -51664, IR IRAN

[2 ]Urology Department, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz -51664, IR IRAN

[3 ]Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz -51664, IR IRAN

[4 ]Students’ Research Committee, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz -51664, IR IRAN

[5 ]Neurosciences Research Center, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz -51664, IR IRAN

[6 ]Gastroenterology Research Center, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz -51664, IR IRAN

Article

Publisher ID: 1471-2490-12-13

DOI: 10.1186/1471-2490-12-13

PMC ID: 3508963

PubMed ID: 22559856

SO-VID: ac5b3df4-78d2-4a86-be15-5dce12690287

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department

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Abstract

Background

Methods

Results

Conclusions

Trial registration

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Preventive and Emergency Medicine Insights

Most cited references 9

Systemic lidocaine for neuropathic pain relief.

Treatment of postoperative paralytic ileus by intravenous lidocaine infusion.

Parenteral lidocaine for treatment of intractable renal colic: a case series

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