A comparative study of intranasal desmopressin and intranasal ketamine for pain management in renal colic patients: A randomized double-blind clinical trial.

BACKGROUNDS AND AIMS: Urolithiasis is one of the most common urological diseases worldwide, commonly presenting as renal colic, requiring analgesic treatment due to the severe pain it causes the patients. This study aimed to compare the efficacy of Ketamine and Desmopressin in the pain management of renal colic patients.

METHODS: This double-blind, randomized clinical trial study was conducted on renal colic patients referred to emergency departments (ED) from June 2021 to July 2022. Patients were randomly assigned to three groups. In the Desmopressin group, patients were treated with intranasal desmopressin and intravenous ketorolac. The ketamine group was treated with intranasal ketamine and ketorolac. The placebo group received ketorolac and an intranasal placebo. Vital signs were evaluated at baseline and 60 minutes and pain scores were assessed at baseline, 10, 30, and 60 minutes after the treatment.

RESULTS: 135 patients enrolled, the mean (standard deviation) of age was 44.1 ± 11.4, and 82 (60.7%) were men. The mean VAS scores were significantly lower at 10, 30, and 60 minutes in ketamine (5.6±1.2, 3.0±1.1, 0.9±0.9) compared to the placebo (8.2±1.1, 5.1±2.0, 2.3±2.6) and desmopressin (6.7±1.8, 4.2±2.2, 1.3±1.4) groups (P<0.05). Although patients in the desmopressin group had lower mean pain scores than the placebo group at 10, 30, and 60 minutes, this difference was only significant at 10 minutes after the intervention (P<0.05). No significant differences were found regarding vital signs 60 minutes after the treatment.

CONCLUSION: Ketamine showed more favorable analgesic effects in renal colic patients than desmopressin, although desmopressin showed promising efficacy in the first minutes of the treatments.