R.E.B.E.L.EM - By Salim Rezaie - Peer review by Anand Swaminathan
"Background: For anyone who has taken care of a patient with renal colic, the agony they experience is indelible. I have had several female patients even tell me that the pain is worse than child birth. Treatment of renal colic comes down to two key components: treatment of pain and expediting passage of the stone. Many medications have been tested for the former, and we have discussed the latter on our blog before (HERE and HERE). We had a recent resident journal club discussing a trial comparing IV lidocaine (1.5mg/kg) vs IV morphine (0.1mg/kg) for treatment of pain...
Author Conclusion: “Changing the smooth muscle tone and reducing the transmission of afferent sensory pathways, lidocaine causes a significant reduction in pain.”
Clinical Take Home Point: IV preservative free (cardiac) lidocaine (1.5mg/kg) seems to be another opioid sparing treatment option in our armamentarium to treat renal colic pain in patients without renal, liver, or cardiac disease, however this single study should not change practice of using NSAIDs as first line opioid sparing therapy where available."