间苯三酚联合体外冲击波碎石治疗输尿管结石所致肾绞痛疗效分析

目的：观察间苯三酚注射液联合体外震波碎石术治疗输尿管结石导致肾绞痛的疗效。方法选择泌尿外科急诊肾绞痛病例428例,随机分成两组,观察组体外震波碎石术前30分钟间苯三酚注射液80mg静滴,对照组行体外震波碎石术。记录30分钟内两组患者的疼痛缓解率和1周后的碎石成功率。结果无论是疼痛缓解率还是一次性碎石成功率,观察组都较对照组有明显优势,两组比较差异有统计学意义（P＜ 0.05）。结论间苯三酚注射液联合体外震波碎石术治疗输尿管结石导致肾绞痛高效、安全,具有临床推广价值。     

酮咯酸联合解痉药物治疗急性结石性肾绞痛的疗效评估

目的 评估酮咯酸联合解痉药物在急性结石性肾绞痛治疗中的作用.方法 对403例急性结石性肾绞痛患者肌注酮咯酸氨丁三醇及654-2,并静脉滴注诺仕帕,补液500～1000 ml.应用视觉模拟评分法分别评估治疗前后疼痛程度,记录副反应及初次治疗后72 h内疼痛复发的情况.结果 352例(87.3%)显效,27例(6.7%)部分显效,24例(6.0%)无效.8例(2.0%)出现轻微中枢神经系统症状,10例(2.5%)出现轻微胃肠道症状,13例(3.2%)出现轻微迷走神经抑制症状.12例(3.0%)于离院72 h内疼痛再发.结论 酮咯酸联合解痉药物并适当补液,疗效好,副反应少,镇痛效果持久,是治疗急性结石性肾绞痛的有效选择.     

妊娠期顽固性肾绞痛的急诊处理

目的探讨妊娠期顽固性肾绞痛的急诊保守治疗方法和可行性。方法回顾性总结21例妊娠合并顽固性肾绞痛的病例,首先肌注山莨菪碱（654．2）10mg和黄体酮20mg,再静脉滴注间苯三酚80mg,常规给予25％硫酸镁静脉滴注,同时注意镁中毒,必要时哌替啶75～100mg肌注;合并感染及时使用敏感抗生素。结果21例患者症状均获缓解,11例在妊娠期内再次发生肾绞痛,再予同样保守治疗后症状缓解,除1例流产（习惯性流产,非结石引起）外,所有患者均顺利渡过围产期顺产或剖腹产。结论急诊保守治疗妊娠期合并顽固性肾绞痛方法安全可行,疗效良好,值得推广。     

间苯三酚联合山莨菪碱治疗下尿路微创手术后膀胱痉挛的疗效观察

目的探究间苯三酚联合山莨菪碱治疗下尿路微创手术后用膀胱痉挛的疗效。方法选取我院2014年1月至2015年1月下尿路微创手术患者204例,按照随机数表法分为实验组(51例)、山莨菪碱组(51例)和M阻滞剂组(51例)和间苯三酚组(51例),实验组为接受间苯三酚联合山莨菪碱治疗的患者,山莨菪碱组接受山莨菪碱治疗,M阻滞剂组仅接受M受体阻滞剂治疗,间苯三酚组仅接受间苯三酚治疗,分别在用药后0~24、25~48和49~72h三个时间段内记录四组患者膀胱痉挛发生次数、持续时间及疼痛程度。结果四组患者用药后各时间段膀胱痉11挛发生次数显示:实验组在用药后0~24h、25~48h、49~72h发生次数分别为(7.12±0.33)、(4.75±0.35)、(3.23±0.53)次,实验组分别与其他三组患者对应时间段相比较差异有统计学意义(P0.05);实验组用药后痉挛持续时间分别为(0.75±0.13)、(0.62±0.21)、(0.52±0.33)h,而山莨菪碱组为(1.57±0.32)、(1.09±0.23)、(0.86±0.41)h,M阻滞剂组分别为(1.43±0.19)、(1.01±0.32)、(0.79±0.30)h,间苯三酚组分别为(1.43±0.19)、(1.01±0.32)、(0.79±0.30),实验组分别与其他三组患者对应时间段相比较差异有统计学意义(P0.05);实验组患者3个时间段内用疼痛VAS评分分数分别为(3.65±0.78)分、(3.12±0.56)分、(2.67±0.34)分,实验组分别与其他三组对应时间段相比较,差异有统计学意义(P0.05)。结论用间苯三酚联合山莨菪碱治疗下尿路微创手术后膀胱痉挛,可减少膀胱痉挛发生次数和时间,并且减轻患者疼痛程度。     

不同止痛药物治疗输尿管结石并肾绞痛疗效观察

目的 对比观察不同止痛药物治疗输尿管结石合并肾绞痛的疗效。方法 回顾性分析2020年3月至2022年11月青岛滨海学院附属医院急诊科收治的157例输尿管结石合并肾绞痛患者的临床资料,按照用药不同,分为4组:A组采用酮咯酸氨丁三醇注射液+消旋山莨菪碱注射液治疗;B组采用地佐辛注射液+消旋山莨菪碱注射液治疗;C组采用哌替啶注射液+消旋山莨菪碱注射液治疗;D组采用间苯三酚注射液+消旋山莨菪碱注射液组治疗。观察各组患者疼痛缓解情况,疼痛缓解时间,不良反应发生率等情况。结果 A组、B组、C组的疼痛评分改善情况优于D组,D组止痛药物起效时间较其他各组更长,A组和D组不良反应发生率低于B组和C组,差异均有统计学意义(均P<0.05)。结论 酮咯酸氨丁三醇注射液和消旋山莨菪碱注射液组合治疗输尿管结石合并肾绞痛止痛效果好,起效时间短,不良反应发生率低。     

比较保守治疗或手术对急诊输尿管中下段小结石性肾绞痛的治疗价值

目的探讨药物保守治疗或输尿管镜碎石取石术两种方法治疗输尿管中下段小结石性。肾绞痛的临床效果。方法2012年7月至2013年4月间将40例输尿管中下段结石性肾绞痛患者随机分为两组。治疗组20例,应用输尿管镜碎石取石术,对照组20例采用排石、解痉药物保守治疗。结果与对照组相比,治疗组。肾绞痛缓解率较高（P〈0．05）;肾绞痛再发生率较低（P〈0．05）;从入组到肾绞痛缓解所需时间平均较短（P〈0．05）。治疗组清除结石的治愈率（95％,19／20）明显高于对照组（55％,11／20）（P〈O．05）,治疗组仅1例治疗失败,但拔出双J管1周后自行排出;对照组中9例保守治疗失败,其中3例通过体外冲击波碎石术治疗排出结石、6例采取输尿管镜碎石取石术最终取出结石。结论输尿管镜下碎石取石术治疗输尿管中下段小结石性肾绞痛可及早解除疼痛、减轻痛苦,且清除结石治愈率高,值得临床推广应用。     

α1联合M受体阻滞剂在输尿管镜碎石术后双J管综合征防治中的应用

目的评估α1受体阻滞剂、M受体阻滞剂以及α1受体阻滞剂联合M受体阻滞剂防治输尿管镜碎石术后双J管综合征的临床疗效。方法排除术前前列腺增生、泌尿系严重感染、泌尿系结核、重度肾积水和总肾功能异常的病例,将输尿管镜碎石术后并符合试验纳入标准的98例患者随机分为空白组（n=22）、α1受体阻滞剂组（n=25）、M受体阻滞剂组（rt=23）以及联合治疗组（n=28）。空白组患者作为空白对照,不给于任何受体阻滞剂干预,其余3组患者术后第2天分别口服α1受体阻滞剂（坦索罗辛,0．2mg,每晚1次）、M受体阻滞剂（托特罗定,2mg,每天2次）、d。联合肘受体阻滞剂（坦索罗辛联合托特罗定,剂量同前）直至术后30d拔除双J管。记录试验期间患者药物治疗的不良反应,比较4组患者术前一般情况,术后24h、拔除尿管后2h和拔除双J管后2h的国际前列腺症状评分（IPSS）、生活质量评分（00L）和视觉疼痛模拟评分（VAS）。结果4组患者均在术后30d时拔除双J管,并完成术后的随访和问卷调查。4组患者术前一般情况差异无统计学意义,术后24h、拔除尿管后2h和拔除双J管后2hIPSS评分显示α1受体阻滞剂组、M受体阻滞剂组和联合治疗组要明显优于空白组（P〈0．05）。联合治疗组术后24h、拔除尿管后2h、拔除双J管后2hQOL评分以及术后2hVAS评分与其他三组比较差异具有统计学意义。拔除尿管后2h和拔除双J管后2hVAS评分三组治疗组疗效优于空白组（P〈0．05）,三组问比较,联合治疗组疗效优于α1受体阻滞剂组和M受体阻滞剂组（P〈0．05）。结论相对于空白组,α1受体阻滞剂、肘受体阻滞剂和联合治疗对输尿管镜碎石术后留置双J管的IPSS评分均有改善作用。联合治疗在减轻术后留置双J管的QOL和VAS评分明显优于单一理。受体阻滞剂或M受体阻滞剂。     

瑞芬太尼对正常和高血压大鼠基底动脉平滑肌细胞的不同作用

目的评价瑞芬太尼对正常和高血压大鼠基底动脉平滑肌细胞上大电导钙激活钾通道(BKCa)和电压门控钾通道(Kv)激活电流的影响。方法自发性高血压大鼠(spontaneously hypertensive rats,SHR)和同源正常血压(wistar-kyoto,WKY)大鼠,采用酶消化法急性分离基底动脉平滑肌细胞,每种大鼠选择6个基底动脉平滑肌细胞,采用全细胞膜片钳技术记录外向电流幅度。加入瑞芬太尼3×10-7mol/L,分别记录所设置的方波刺激(step刺激)方案中所有刺激电压下给药前(基础水平)和给药后电流幅度,并计算净电流=给药后电流幅度-基础值;采用浓度累积法给药,分别记录+60 m V刺激电压下给药前(基础值)和给予10-10、10-9、10-8、10-7、10-6、10-5mol/L瑞芬太尼后电流幅度,计算电流增加率和瑞芬太尼增加基底动脉平滑肌细胞电流幅度的半数有效浓度(EC50);另取每种大鼠6个基底动脉平滑肌细胞,加入瑞芬太尼3×10-7mol/L后分别给予BKCa阻滞剂四乙胺(tetraethylammonium,TEA)和Kv阻滞剂4-氨基吡啶(4-aminopyridine,4-AP),再分别加入其相应的瑞芬太尼混合液,记录每一次给药后的电流幅度。结果两种大鼠基底动脉平滑肌细胞给瑞芬太尼后在0、+20、+40和+60 m V刺激电压下产生的净电流依次明显增大(P0.05);10-10、10-9、10-8、10-7mol/L瑞芬太尼作用下,两种大鼠基底动脉平滑肌细胞外向电流增加率依次明显升高(P0.05);与WKY大鼠比较,瑞芬太尼增加SHR基底动脉平滑肌细胞电流幅度的(EC50)明显升高(P0.05);与基础值比较,两种大鼠基底动脉平滑肌细胞瑞芬太尼给药后电流幅度明显升高,TEA给药后或4-AP给药后电流幅度明显降低(P0.05);与TEA给药后或4-AP给药后比较,TEA+瑞芬太尼给药后或4-AP+瑞芬太尼给药后两种大鼠基底动脉平滑肌细胞电流幅度明显升高(P0.05)。结论瑞芬太尼呈电压依赖性和浓度依赖性激活两种大鼠基底动脉平滑肌细胞BKCa和Kv电流,瑞芬太尼对SHR基底动脉平滑肌细胞上BKCa和Kv激活电流的作用较WKY大鼠弱。     

血清PSA对服用托特罗定和／或坦洛新的下尿路症状患者疗效的影响

下尿路症状（LUTS）的产生主要由膀胱、前列腺疾病引起。5α-还原酶抑制剂、α-受体阻滞剂已经被广泛地应用于由BPH引起的LUTS症状。在男性膀胱疾病的患者中,如OAB引起的LUTS症状,应用推荐剂量的M受体阻滞剂联合α受体阻滞剂可以明显缓解LUTS症状,且不会影响生理膀胱排尿功能,发生急性尿潴留。有报道,血清PSA与前列腺体积密切相关,也与LUTS症状、急性尿潴留及手术风险等密切相关,PSA≥1．5ng／mL明显增加PCa的发病风险。     

急诊输尿管镜碎石术与ESWL治疗输尿管中下段结石并急性肾绞痛的疗效评价

目的 比较急诊输尿管镜下气压弹道碎石术（ureteroscopic lithotripsy,URSL）与体外冲击波碎石术（extracorporeal shock wave lithotripsy,ESWL）治疗输尿管中下段结石并急性肾绞痛的疗效.方法 回顾性分析本院近3年来45例急诊URSL（URSL组）以及51例急诊ESWL（ESWL组）治疗输尿管中下段结石并急性肾绞痛患者的临床资料,比较其疼痛缓解率、一次性碎石成功率、术后2周结石排净率、并发症发生率等指标.结果 URSL组和ESWL组疼痛缓解率分别为95.56％（43/45）和78.43％（40/51）（P＜0.05）,URSL组一次性碎石成功率和术后2周碎石排净率分别为93.33％ （42/45）、97.78％ （44/45）,明显优于ES-WL组的78.43％ （40/51）、82.35％（42/51）（P＜0.05）;URSL组术后有2例发生尿路感染,ESWL组术后有4例发生肉眼血尿,两组术后均未出现发热、输尿管穿孔、撕裂等并发症（P＞0.05）.结论 对于结石直径＞l0mm的输尿管中下段结石并急性肾绞痛患者,急诊输尿管镜术疗效优于体外冲击波碎石术;首选输尿管镜术治疗此类患者具备一定的临床推广价值.     

Is there a role for antimuscarinics in renal colic? A randomized controlled trial

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.     

Pain killers and antibacterial therapy for kidney colic and stones

In 85% of patients, renal colic is caused by renal-ureteral stones with extrinsic obstructions such as pelvic, retroperitoneal or intestinal abnormalities, and intrinsic reno-ureteral obstructions, e.g. junction pathologies and malformation, accounting for only 10 and 5%, respectively. The objectives of therapy for renal colic therapy are to eliminate pain, preserve renal function and eliminate the obstruction by the excretory pathway. Many drugs can be used to relieve pain: non-steroid anti-inflammatory agents (NSAIDs), opioid analgesics, antidiuretic hormone (ADH), loco-regional anesthesia and acupuncture. Opiates are the first-choice therapy during pregnancy as no other drug is indicated because of tetragenic potential. Paracetamol (N-acetyl-p-aminophenol) is the only NSAID that is registered for pediatric use because it has none of the adverse side effects that are associated with NSAIDs. Tamsulosin, an alpha-lithic drug, has very recently been included among the drugs that are used for stone expulsion. The rationale underlying its use is that a high concentration of alpha-1D adrenergic receptors has been recently detected in the terminal ureter, especially in the intramural tract. Inhibition of alpha-1D receptor stimulation should relax smooth muscle in the intramural ureteral tract, making stone expulsion easier.     

Comparing analgesic efficacy of non-steroidal anti-inflammatory drugs given by different routes in acute and chronic pain: A qualitative systematic review

Aim : To test the evidence for a difference in analgesic efficacy and adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs) given by different routes.
Methods : Systematic review of published randomised controlled trials. Relevant trials were comparisons of the same drug given by different routes. Presence of internal sensitivity was sought as a validity criterion. Analgesic and adverse effect outcomes were summarised, and synthesised qualitatively.
Results : In 26 trials (2225 analysed patients), 8 different NSAIDs were tested in 58 comparisons. Fifteen trials (58%) compared the same drug by different routes. Drugs were given by intravenous, intramuscular, intrawound, rectal and oral routes in postoperative pain (14 trials), renal colic (4), acute musculo-skeletal pain (1), dysmenorrhoea (1), and rheumatoid arthritis (6). Five of the 15 direct comparisons were invalid because they reported no difference between routes but without evidence of internal sensitivity. In all 3 direct comparisons in renal colic, intravenous NSAID had a faster onset of action than intramuscular or rectal. In 1 direct comparison in dysmenorrhoea, oral NSAID was better than rectal. In the 5 direct comparisons in postoperative pain, results were inconsistent. In 1 direct comparison in rheumatoid arthritis, intramuscular NSAID was better than oral. Injected and rectal administration had some specific adverse effects.
Conclusion : In renal colic there is evidence that NSAIDs act quickest when given intravenously. This may be clinically relevant. In all other pain conditions there is a lack of evidence of any difference between routes. In pain conditions other than renal colic, there is, therefore, a strong argument to give oral NSAIDs when patients can swallow.     

Pharmacology of systemic analgesics

Systemic administration of analgesic drugs is still the most widely used method for providing pain relief in acute painful situations. Opioids may be selected on the basis of their physicochemical characteristics and their diffusion index to the brain. But in clinical practice, their very steep concentration-analgesic effect relationship remains a critical aspect of opioid therapy. Thus, small fluctuations in plasma concentrations of opioids may lead to profound fluctuations in analgesic effect when their plasma and effect-site concentrations are near the minimum effective analgesic concentration (MEAC). Combining drugs acting on different mechanisms of nociceptive modulation offers benefits from additive/synergistic effects and will decrease the incidence of their adverse effects. Evidence-based reviews showed that effective pain relief using non-opioid analgesics relied on paracetamol supplemented with non-steroidal anti-inflammatory drugs (NSAIDs). The role of COX-2 selective inhibitors (CSIs) in acute pain relief still requires further evaluation. NSAIDs, CSIs and paracetamol share the property of morphine sparing in situations of severe (post-operative) pain. CSIs may be beneficial in patients in whom post-operative bleeding is a major surgical risk as the effects of NSAIDs on coagulation may last for days. Finally, low-dose ketamine infusions remain a worthwhile addition to opioid therapy. Analgesic concentrations of ketamine are 1/5th to 1/10th the anaesthetic concentration and exert significant inhibition on N-methyl-d-aspartate (NMDA) receptor activation.     

Treatment of Renal Colic by Desmopressin Intranasal Spray and Diclofenac Sodium

The vasopressin analogue, 1-desamino-8-arginine vasopressin (desmopressin), is a potent antidiuretic without the pressor effects of vasopressin. A total of 18 patients with acute renal colic due to stone disease received 40 microgram desmopressin intranasal spray with encouraging results. There was a significant decrease in the colic pain intensity from an initial mean visual analogue score of 67 plus/minus 17 mm. to 39 plus/minus 36 mm. within 30 minutes (p less than 0.001). Eight patients (44.4 percent) had complete pain relief within 30 minutes of administering intranasal desmopressin spray. Nine of 10 patients who required intramuscular diclofenac sodium achieved complete pain relief within another 30 minutes. In other words, when intranasal desmopressin spray was administered before diclofenac sodium, 94.4 percent of the patients achieved complete pain relief and were discharged home.The mechanism of analgesic action of desmopressin in renal colic is uncertain. At the peripheral level, desmopressin may alleviate the acute renal colic through its potent antidiuretic effect or by relaxing the renal pelvic and ureteral smooth muscles. The central analgesic effect of desmopressin by stimulating the release of the hypothalamic beta-endorphin is proposed. We conclude that intranasal desmopressin spray can be used successfully in the treatment of renal colic. It may also replace prostaglandin synthetase inhibitors in treating renal colic with the advantage of avoiding the potential side effects. Further studies are needed to investigate whether the combination of desmopressin with analgesics or spasmolytic drugs offers competitive results compared with those achieved by prostaglandin synthetase inhibitors in the treatment of renal colic.     

Emergency treatment of renal colic with intravenous Ketoprofen

The non-steroidal anti-inflammatory drug (NSAID) Ketoprofen (Profenid) is used as intravenous monotherapy incorporated in 0.9% normal saline solution (100 mg Ketoprofen ampoule +200 ml normal saline) in the treatment of renal colic. We present our experience in 65 patients complaining of clinically diagnosed renal colic who were treated by intravenous saline-Ketoprofen. Prospective investigations revaled urinary calculi in 51 patients, oxaluria (crystalluria) in 5, acute colitis in 2, severe myositis in 2, negative investigations in 3 and radiculitis in 2 patients. Positive response was observed in 93.8% of patients as far as pain relief is concerned. Pain relief started within 5–7 minutes after beginning the infusion. Duration of analgesic effect ranged between 4 and 12 hours. Repeating the injection was done for maintenance of analgesia. Side effects included drowsiness in 2 patients, palpitation in 1 patient, epigastric pain in 1, muscular cramp in 1 patient. Ketoprofen, an antiprostaglandin, is a powerful anti-inflammatory and potent analgesic. Intravenous saline-Ketoprofen is a good emergency treatment for acute episodes of renal colic.     

肾绞痛患者体外冲击波碎石术最佳治疗时机探讨

目的 寻找伴有肾绞痛的输尿管结石行体外冲击波碎石术(extracorporeal shockwave lithotripsy,ESWL)的最佳治疗时机.方法 跟踪观察行ESWL的伴有肾绞痛的输尿管结石患者505例,按肾绞痛发作至ESWL的时间间隔分为三组:A组(肾绞痛发作时行ESWL,或急诊ESWL)123例;B组(肾绞痛缓解后3～6d内行ESWL)162例;C组(肾绞痛缓解7d后行ES-WL)220例.观察三组一次碎石成功率、2周结石排净率、再发肾绞痛率及肾内感染发生率并进行比较.结果 A组所有患者经ESWL治疗约5～ 15 min肾绞痛症状明显缓解或消失,绞痛缓解率100％.虽然A组、B组的1次碎石成功率、2周结石排净率均优于C组,差异均有统计学意义(P＜0.05),但A组与B组比较,均无显著差异(P＞0.05).而A组术后再发肾绞痛率和并发肾内感染率分别为50.4％和17.1％,明显高于B组的4.9％和5.6％以及C组的6.8％和5.9％,差异均有统计学意义(P＜0.01).结论 输尿管结石伴有肾绞痛患者应尽早行ESWL治疗,疼痛缓解率高,但应用ESWL的最佳治疗时机为肾绞痛缓解后3～6d内.     

Ketorolac: safe and effective analgesia for the management of renal cortical tumors with partial nephrectomy

PURPOSE: Ketorolac has demonstrated advantages as a supplement to opioid based analgesia in several surgical settings, including donor nephrectomy. To our knowledge there has been no published data to date on the use of ketorolac in patients undergoing partial nephrectomy. We compared analgesia with ketorolac and opioids to analgesia with opioids alone with regard to pain control, postoperative recovery and effects on renal function in patients with renal cortical tumors surgically managed by partial nephrectomy. MATERIALS AND METHODS: Records for 154 patients treated with partial nephrectomy for renal cortical tumors were retrospectively analyzed. Clinicopathological variables examined were age, gender, medication use, comorbidity profile, operation side, estimated blood loss, hospital stay, operative duration, American Society of Anesthesiologists class, histopathology results, perioperative transfusion status, ischemia type (warm vs cold vs none), duration of renal artery cross clamping, tumor size and intraparenchymal location, pathological stage and perioperative complications. Postoperative duration to the initiation of solid diet, discontinuation of patient controlled analgesia and overall pain control were assessed. Serum creatinine was measured during the preoperative period, and at 1, 3 or greater and 30 or greater days postoperatively. RESULTS: Patients who received ketorolac demonstrated superior postoperative recovery with an earlier return to solid diet and earlier discontinuation of patient controlled analgesia. Treatment groups were similar with respect to changes in serum creatinine, blood loss, transfusion rates and complication rates. Ketorolac was not associated with an increased risk of acute renal failure. CONCLUSIONS: Ketorolac is a safe and effective supplement to opioid based analgesia for pain control after partial nephrectomy.     

Use of intravenous ketorolac in the neonate and premature babies

BACKGROUND: Ketorolac is a powerful nonsteroidal anti-inflammatory drug widely used for pain control in children and adults. The aim of this study was to evaluate its safety and analgesic efficacy in the neonate. METHODS: Ketorolac was used in a group of 18 spontaneously breathing neonates presenting with chronic lung disease, for the control of postsurgical pain and pain from invasive procedures. Pain scores (Neonatal Infant Pain Scale) were assessed before and after i.v. administration of 1 mg.kg(-1) of ketorolac. RESULTS: Total pain control was achieved in 94.4% of the neonates. None of the neonates had haematological, renal or hepatic changes prior to treatment, and these complications did not occur after treatment. No neonate had systemic haemorrhage or bleeding from injection and blood withdrawal sites. CONCLUSIONS: Ketorolac could represent an efficacious analgesic alternative to opioids, particularly in neonates. It would avoid the side-effects associated with opioid analgesics, especially respiratory depression.