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Papaverine improves analgesia for renal colic

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Pain associated with acute renal colic is relieved more effectively when intravenous papaverine is added to treatment with diclofenac suppository, an Iranian team reports in BJU International online February 20.

“We think that this method could reduce the usage of opioids and NSAIDs in the treatment of renal colic,” the authors comment.

While NSAIDs are the mainstay of treatment for acute renal colic, they explain, the spasmolytic effect of papaverine could counteract painful isotonic contractions that occur with ureteric obstruction.

Dr. Ali Hamidi Madani, with Guilan University of Medical Sciences and Razi Hospital, Iran, and colleagues conducted a randomized trial with 550 patients with suspected acute renal colic who received 100 mg diclofenac sodium suppository with an IV infusion of either 1.5 mg/kg papaverine hydrochloride or saline placebo.

Pain scores on a 0-10 visual analog scale at baseline were 9.30 in the papaverine and 9.16 in the placebo group. VAS scores declined to 5.82 vs 6.80, respectively, at 20 minutes, and to 3.16 vs 4.32 at 40 minutes. The differences at both time points were significant (p<0.001), the investigators found.

Patients were offered additional analgesia with 25 mg pethidine IM if they needed it. This was not requested by 90.9% of patients in the diclofenac- papaverine group and 71.1% of those in the diclofenac monotherapy group, the report indicates.

Ten patients given papaverine reported dizziness, “which was managed conservatively,” Dr. Madani and colleagues note.

Summing up, they conclude, “We suggest that i.v. papaverine hydrochloride may be a useful supplemental therapy for renal colic with no serious side-effects especially combined with NSAIDs.”

They add, “As the present study was conducted in suspected cases of renal colic, we suggest further studies in confirmed cases of renal colic.”

SOURCE:

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

BJU Int 2012.