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Toradol and analgesia for renal colic

bensonblues at comcast.net bensonblues at comcast.net
Sun Apr 2 21:01:05 BST 2006


Pret, et al: 

My Irish mum told me that I mistreated my lepracaun and thus inherited the curse of the kidney stone (blarney, I say!), so I have special interest here. The analgesia sometimes seen (clinical results are inconsistent) with ketorolac is in part due to the decrease in renal blood flow/GFR (which decreases the pressure head favoring stone passage into the bladder), as well as the amelioration of prostaglandin-mediated ureteral peristalsis (which also favors stone progress). I suspect its routine use may delay passage of stones (most are 3-4 mm and pass spontaneously) which can increases risk of complication (infection from stasis). I treat many patients with stones, and I believe it is best to induce diuresis (unless they have hydronephrosis) with IV fluids and treat their agony with hydromorphone and sometimes lorazepam. The fact that ketorolac is indicated for treatment of mild to moderate pain should alert you: Anyone who has experienced the pain of renal colic will tell you that it anything but mild or moderate - it is agony. Nonetheless, I'll bet that if it were your stone, you'd be more than happy to see my ugly face leaning over your stretcher. Just a guess. Regarding the study - I've looked into it, but getting it funded is the first hurdle. I think the folks in Schaumburg, IL who own the drug are reluctant to risk a negative study. Almost every positive study about that drug was funded by them, though. Imagine that. The point is safety: opiates are safe with a thousand years of experience, ketorolac has about a 15 year history, and the manufacturers recommended that we don't use it for more than 5 days. Hum. 

DB


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