Comparison of the Effectiveness of Intranasal Ketamine, Intravenous Morphine Sulfate, and Intravenous Ketorolac in Reducing the Pain of the Renal Colic Patients

Determining the comparative effect of intranasal ketamine, intravenous morphine and intravenous ketorolac in reducing pain in patients with renal colic.

A phase 4 randomized, double-blind, parallel-group, controlled clinical trial on 99 patients. The rand function of Excel was used for randomization.

9 patients with renal colic referred to Shohada Ashayer Hospital in Khorramabad who are randomly assigned to treatment with morphine sulfate, ketamine or ketorolac. Patients' pain intensity is evaluated at 15, 30, 45 and 60 minutes after drug administration. Patients, drug-injecting nurses, and pain-asking physician are blinded.

Inclusion criteria: Patients referred to the emergency department of Shohada Ashayer Hospital from August 23 to September 22, 2023 who have the following conditions: 1. Patients over 18 years old 2. Having symptoms of renal colic: pain on one or both sides of the patient 3. Diagnosis of kidney stone in CT scan or sonography Exclusion criteria: 1. Pregnant women 2. Addiction to opioids 3. History of allergy to morphine, ketamine or ketorolac 4. Nasal obstruction 5. Systolic blood pressure higher than 180 or lower than 90 mmHg 6. Respiratory distress 7. Decreased level of consciousness 8. Patients who do not have the necessary cooperation 9. History of gastrointestinal bleeding 10. Asthma patients 11. Receiving medication in the past 48 hours

For patients in group A, 1mg/kg of ketamine intranasally and 5cc of normal saline intravenously, for patients in group B, 0.1mg/kg of morphine sulfate intravenously and 5cc of normal saline intranasally, and for patients in group C, 60mg of ketorolac intravenously and 5cc of normal saline intranasally will be injected.

Pain intensity based on Visual Analogue Scale

We will stratify the patient into three groups according to the severity of the pain (1 to 4, 5 to 7 & 8 to 10), then we will use block randomization in each of these groups for finding the members of each prescription group.

The patients will be randomly divided into three groups. For patients in group A, 1mg/kg of ketamine intranasally and 5cc of normal saline intravenously will be prescribed, in patients in group B, 0.1mg/kg of morphine sulfate intravenously and 5cc of normal saline intranasally will be used, and in patients in group C, 60mg of ketorolac intravenously and 5cc of normal saline intranasally will be injected. In injecting these drugs, a group of nurses will prepare the prescribed drugs in 5cc syringes according to the pre-designed block randomization method, and if the drug fills less than the syringe volume, they will dilute it with distilled water to reach 5cc volume and without informing the contents, only by specifying the route of drug injection, they will provide it to another group of nurses who are responsible for injecting the drug. It should be noted that patients will not be informed of the type of drug prescribed. The pain level of patients before drug injection and at minutes 15, 30, 45 and 60 after drug administration will be evaluated based on the VAS scale, the responsibility of pain score assessment in all patients will be performed by an experienced specialist physician who is not aware of the type of drug prescribed in the patient and finally the difference between the VAS score before drug administration and the specified times after drug administration will be used as a criterion for evaluating the success of drugs in reducing pain.

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