Treatment of loin pain suspected to be renal colic with papaverine hydrochloride: a prospective double‐blind randomised study

Abstract

Study Type – Therapy (RCT) Level of Evidence 1b What's known on the subject? and What does the study add? Results of our study showed that intravenous papaverine hydrochloride plus suppository sodium diclofenac were more effective than diclofenac sodium suppository alone in the treatment of acute renal colic. Therefore, intravenous papaverine hydrochloride may be a beneficial supplemental therapy to relieve renal colic pain, particularly in combination with NSAIDs. OBJECTIVE To assess the efficacy of papaverine hydrochloride combined with a diclofenac sodium suppository to relieve renal colic compared with diclofenac suppository monotherapy, as the effect of phosphodiesterase inhibitors on ureteric muscles might reduce the pain of renal colic. PATIENTS AND METHODS A prospective, double‐blind clinical study was performed. In all, 550 patients aged 17–55 years with acute renal colic were randomised to two groups. Patients in one group (group A) received a diclofenac suppository (100 mg) plus saline 0.9% (placebo) and the other group (group B) received a diclofenac suppository (100 mg) plus intravenous (i.v.) papaverine hydrochloride (1.5 mg/kg up to120 mg). Pain intensity was assessed using a visual analogue scale (VAS) at 0, 20 and 40 min after treatment. Further analgesia was provided at the patients' request (25 mg pethidine intramuscularly). RESULTS Baseline characteristics (sex, age, past history of similar pains) were similar in the two groups. There were significant differences in VAS pain scores between 0 and 20 min and 0 and 40 min in both groups (P < 0.001). At the end of study, 71.1% of patients in group A and 90.9% of patients in group B reported pain relief and did not require pethidine, respectively. Significantly more patients in group A required further analgesia. CONCLUSIONS According to our results, i.v. papaverine hydrochloride plus a diclofenac suppository were more effective than the diclofenac suppository alone for treating acute renal colic. Therefore, i.v. papaverine hydrochloride is a beneficial supplemental therapy to relieve renal colic pain, particularly combined with non‐steroidal anti‐inflammatory drugs.

Therapeutic Approaches for Renal Colic in the Emergency Department: A Review Article

“…The only reported side effect of papaverine is dizziness, which occurs in only a small percentage of patients (2%) (42). Snir et al concluded that using papaverine in the treatment of renal colic is as effective as sodium diclofenac in the management of patients with renal colic pain in the short term, and can be effective if there are contraindications for the use of NSAIDs; however, the analgesic effect of diclofenac in controlling pain lasts longer than papaverine (43).…”

Papaverine increases human serum albumin glycation

“…It is also used to prevent spasmodic pains [36]. Papaverine dosage depends on the type of disease; as a pain killer it can be administered by IV at doses ranging from 30 to 120 mg every 3 h and in this study it was used in the physiological dosage range [37,38]. Circular dichroism (CD) is an excellent tool for studying secondary structure [39].…”

Adult Wilms tumor with inferior vena cava thrombus and distal deep vein thrombosis – a case report and literature review

“…The latter reaches in most cases below the iliac bifurcation and may be followed by symptomatic pulmonary embolism in up to 27% of cases [ 18 , 19 ]. The incidence of the concomitant bland thrombus was found to be higher in more advanced levels of tumor thrombus [ 22 ].…”

“…If intrahepatic IVC or renal veins are involved, patient may present symptoms of renal congestion and Budd–Chiari syndrome (i.e., hepatomegaly, ascites, and jaundice) [ 23 – 25 ]. Patients with chronic IVC obstruction develop venous collaterals diagnosed either radiographically (e.g., dilated lumbar-hemiazygos veins), or clinically (e.g., dilated abdominal wall veins) [ 22 , 26 ]. The presence of collateral venous pathways, deep and superficial, is responsible for the lack of severe IVC obstruction symptoms.…”

“…Several factors, such as degree, level, and duration of venous obstruction, presence of collateral vessels should be evaluated before the treatment to determine the feasibility and extent of the surgery. Resection of IVC is not required as long as tumor and bland thrombi are completely removed [ 22 ]. However, when IVC resection is necessary, its internal diameter can be decreased by 50% without significant blood flow impairment [ 26 , 29 ].…”