American Journal of Emergency Medicine 38 (2020) 1939

Correspondence

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The authors reply: ISWI vs diclofenac for renal colic

We thank the authors for their comments on our recent article “In- tradermal sterile water injection (ISWI) versus Diclofenac sodium in acute renal colic pain: A randomized controlled trial” [1].

The authors stated that our article [1] presented no specific informa- tion in the text or on a flow diagram that described the selection meth- odology (eligibility, exclusion criteria, written informed consent) for the final target study population (ISWI group, Diclofenac group, and control group). We didn’t agree with their comment. We included in the meth- odology section, a clear part about the inclusion and exclusion criteria of the final population, we also clearly mentioned that informed consent was taken from the patients. Inclusion criteria were patients presented to the ED for acute renal colic who was diagnosed later on with ureteral or Kidney stones by non-contrast enhanced computed tomography (CT). Where the exclusion criteria were infection in the area of injection, patients more than 60 years old or less than 18 years old, patients who have received any analgesic beforethe presentation. Automatically, pa- tients in whom the presence of stone was not proved by CT were ex- cluded from the study.

The authors stated that we should have more clearly explained our rationale in administering ISWI or placebo instead of a traditional anal- gesic for patients with intolerable pain. In practice, the treatment of acute renal colic is mainly based on taking an NSAID, or morphine when the NSAID does not adequately control the pain or when it is bet- ter to avoid using NSAIDs. Both treatment modalities are associated with many side effects that we discussed in our article. Data on other types of non-opioid, non-NSAID medications were scarce. As we discussed in our article, there is a need for an opioid and NSAID sparing therapy with similar efficacy for acute renal colic pain. Indeed, future

research efforts and discussions would be well directed towards the verification of our results.

Finally, all eligible participants were randomly assigned to one of the three treatment groups by a computer-generated lottery and agreed to enter the study. If they took a placebo, we clarified in the consent form that they will take adequate therapy to relieve their persistent pain.

Declaration of competing interest

None.

References

[1] Moussa M, Papatsoris AG, Abou Chakra M. Intradermal sterile water injection versus diclofenac sodium in acute renal colic pain: a randomized controlled trial [published online ahead of print, 2020 Apr 29] ; 2020.

Mohamad Moussa

Head of Urology Department, Zahraa Hospital, University Medical Center,

Beirut, Lebanon

Corresponding author.

E-mail address: [email protected]

Athanasios G. Papatsoris 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece

Mohamed Abou Chakra

Department of Urology, Faculty of Medical Sciences, Lebanese University,

Beirut, Lebanon

20 May 2020

https://doi.org/10.1016/j.ajem.2020.05.057

0735-6757/(C) 2020