Emergency Medicine

Intradermal sterile water injection in acute renal colic

Journal logoUnlabelled imageIntradermal sterile water injection in a”>American Journal of Emergency Medicine 40 (2021) 204

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Intradermal sterile water injection in acute renal colic

We read the article “Intradermal sterile water injection (ISWI) ver- sus Diclofenac sodium in Acute renal colic pain: A randomized controlled trial” by Moussa et al. [1] with interest. The authors aimed to evaluate the efficacy and safety of 0.5 cm3 ISWI compared with an Intramuscular injection of 75 mg diclofenac sodium and with a placebo (intracutane- ous injections of 0.5 cm3 isotonic saline) to relieve the pain of patients who presented to the Emergency Department (ED) with acute renal colic. They concluded that both modalities, ISWI and diclofenac sodium injections, equally relieved pain and maintained their efficacies over the observation period.

Acute renal colic is excruciatingly painful; its severity is comparable to that of labor pain. Patients frequently need aggressive and adequate analgesia. The most essential goal of treatment for acute renal colic in the ED is immediate and complete pain control. The most effective treatments for this are non-steroidal anti-inflammatory drugs, paracet- amol, and opioids, alone or in combination with each other [2].

The overwhelming majority of patients consider a fast onset of ac- tion, complete pain relief, and no recurrence of discomfort as very im- portant to acute renal colic pain management. Failure to address these concerns is associated with decreased patient satisfaction and an in- creased duration of stay in the ED [2,3]. The trial by Moussa et al. ap- peared to have been performed on patients with acute onset renal colic, as the pain Visual analogue scale scores at initial ED presentation were very high: 9.6 +- 0.61 in the ISWI group, 9.72 +- 0.64 in the diclofenac group, and 9.26 +- 0.89 in the control group.

However, the article presented no specific information in the text or on a flow diagram that described the selection methodology (e.g., eligibility, exclusion criteria, written informed consent) for the final target study population. For example, how many patients were ex- cluded because they refused to consent? Additionally, the authors should have more clearly explained their rationale in administering ISWI or a placebo instead of a traditional analgesic for patients with in- tolerable pain and clarify whether patients understood and agreed in writing to the possibility that they were receiving a placebo only.

Declaration of competing interest

None.

References

  1. Moussa M, Papatsoris AG, Chakra MO. Intradermal sterile water injection versus diclofenac sodium in acute renal colic pain: a randomized controlled trial. Am J Emerg Med. 2020. https://doi.org/10.1016/j.ajem.2020.04.079.
  2. Pathan SA, Mitra B, Cameron PA. A systematic review and meta-analysis comparing the efficacy of nonsteroidal anti-inflammatory drugs, opioids, and paracetamol in the treatment of acute renal colic. Eur Urol. 2018 Apr;73(4):583-95.
  3. Gottlieb M, Long B, Koyfman A. The evaluation and management of urolithiasis in the

ED: a review of the literature. Am J Emerg Med. 2018 Apr;36(4):699-706.

Yalcin GolcukAsist. Prof. Dr.

Mugla Sitki Kocman University, Faculty of Medicine, Department of

Emergency Medicine, Mugla, Turkey E-mail address: [email protected]

Ahmet DemirAsist. Prof. Dr.

Mugla Sitki Kocman University, Faculty of Medicine, Department of

Emergency Medicine, Mugla, Turkey

Birdal YildirimAsist. Prof. Dr.

Mugla Sitki Kocman University, Faculty of Medicine, Department of

Emergency Medicine, Mugla, Turkey

Ethem AcarAsist. Prof. Dr.

Mugla Sitki Kocman University, Faculty of Medicine, Department of

Emergency Medicine, Mugla, Turkey

3 May 2020

https://doi.org/10.1016/j.ajem.2020.05.060 0735-6757/(C) 2020 Published by Elsevier Inc.

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