Comparing intranasal ketamine with intravenous fentanyl in reducing pain in patients with renal colic: A double-blind randomized clinical trial.

BACKGROUND: Kidney stones are a fairly common problem that manifests itself as symptoms of acute abdominal and flank pains in patients presenting to emergency departments. OBJECTIVE: The present study was conducted to compare the analgesic effect of intravenous fentanyl with that of intranasal ketamine in renal colic patients. METHODS: One mg/kg of intranasal ketamine was administered in the first group, and one µg/kg of intravenous fentanyl in the second group. The pain severity was measured in the patients in terms of a visual analogue scale (VAS) score at the beginning of the study and at minutes 5, 15 and 30, and the medication side-effects were evaluated and recorded. RESULTS: A total of 130 patients were ultimately assessed in two groups of 65. In the ketamine group, the mean severity of pain was 8.72 ±â€¯1.52 at the beginning of the study (P < 0.001), 5.5 ±â€¯2.97 at minute 5 (P < 0.001), 3.38 ±â€¯3.35 at minute 15 (P = 0.004) and 2.53 ±â€¯3.41 at minute 30 (P = 0.449). In the fentanyl group, this severity was 9.66 ±â€¯88.8 in the beginning of the study (P < 0.001), 7.27 ±â€¯1.37 at minute 5 (P < 0.001), 4.61 ±â€¯1.5 at minute 15 (P = 0.004) and 1.24 ±â€¯1.25 at minute 30 (P = 0.449). The general prevalence of the medication side-effects was 10 (15.4%) in the ketamine group and 1 (1.5%) in the fentanyl group (P = 0.009). CONCLUSIONS: Ketamine was found to be less effective than fentanyl in controlling renal colic-induced pain, and to be associated with a higher prevalence of side-effects; nevertheless, ketamine can be effective in controlling this pain in conjunction with other medications.