Effects of Adding Oral Clonidine to Standard Treatments on Pain Intensity of Patients with Acute Renal Colic: A Randomized Clinical Trial

Background: The aim of this study was to compare the effect of adding oral clonidine to standard treatments on pain intensity in patients with acute renal colic. Materials and Methods: This is a randomized clinical trial that was performed in 2020 in Isfahan. The study population consisted of 200 patients with renal colic. Pain of the patients was assessed using Visual Analog Scale. Patients were then randomized into 4 groups of 50 patients. Group A received 0.1 mg/kg morphine and clonidine tablets (0.2 mg). Group B received morphine and placebo. Group C received 30 mg ketorolac and clonidine tablets. Group D received 30 mg ketorolac and placebo tablets. Pain of patients was assessed. 0.05 mg/kg morphine was administered and repeated every 40 min if the pain was not reduced. Results: Our data showed that there was a significant difference between pains of patient by the time of admission in groups (P = 0.04). However, no significant differences were observed between pains of patients in different measuring times (P > 0.05). Using general linear model, we showed that the decreases in pain scores of each group were significant (P < 0.05) but there were no significant differences in pains of patients in different measuring times (P > 0.05). Our data showed that Group A and Group C had lowest frequencies of morphine administrations while Groups B and D had the highest frequencies (P < 0.001). Conclusion: We showed that administration of clonidine in patients with renal colic resulted in better pain control and lower morphine injections.

[1]  A. Manolis Faculty Opinions recommendation of Spironolactone Versus Clonidine as a Fourth-Drug Therapy for Resistant Hypertension: The ReHOT Randomized Study (Resistant Hypertension Optimal Treatment). , 2020 .

[2]  K. Rimtebaye,et al.  Renal Colic: Epidemiological, Clinical Etiological and Therapeutic Aspects at the Urology Department of the National Reference General Hospital of N’Djamena (Chad) , 2020 .

[3]  C. Bai,et al.  Safety and efficacy of clonidine on postoperative vomiting and pain in pediatric ophthalmic surgery: A systematic review and meta‐analysis , 2019, Paediatric anaesthesia.

[4]  Jonathan E. Shoag,et al.  Kidney Stones and Risk of Narcotic Use. , 2019, The Journal of urology.

[5]  Alireza Baratloo,et al.  Low-dose intravenous ketamine versus intravenous ketorolac in pain control in patients with acute renal colic in an emergency setting: a double-blind randomized clinical trial , 2019, The Korean journal of pain.

[6]  Yu-Ming Niu,et al.  Increasing Nonsteroidal Anti-inflammatory Drugs and Reducing Opioids or Paracetamol in the Management of Acute Renal Colic: Based on Three-Stage Study Design of Network Meta-Analysis of Randomized Controlled Trials , 2019, Front. Pharmacol..

[7]  Saeed Safari,et al.  Comparison of Intravenous Ibuprofen with Intravenous Ketorolac in Renal Colic Pain Management; A Clinical Trial , 2019, Anesthesiology and pain medicine.

[8]  G. Guyatt,et al.  Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis , 2018, JAMA.

[9]  B. Bolaji,et al.  Dose related effects of oral clonidine pre-medication on bupivacaine spinal anaesthesia , 2018, African health sciences.

[10]  P. Lotufo,et al.  Hypertension News-Screen: Spironolactone versus Clonidine as a Fourth-Drug Therapy for Resistant Hypertension Œ The ReHOT Randomized Study (Resistant Hypertension Optimal Treatment) , 2019 .

[11]  P. Cameron,et al.  A Systematic Review and Meta-analysis Comparing the Efficacy of Nonsteroidal Anti-inflammatory Drugs, Opioids, and Paracetamol in the Treatment of Acute Renal Colic. , 2017, European urology.

[12]  Wei He,et al.  Efficacy and Safety of Tamsulosin in Medical Expulsive Therapy for Distal Ureteral Stones with Renal Colic: A Multicenter, Randomized, Double-blind, Placebo-controlled Trial. , 2017, European urology.

[13]  M. Masud,et al.  Role of Oral Clonidine Premedication on Intra-operative Haemodynamics and PONV in Laparoscopic Cholecystectomy. , 2017, Mymensingh medical journal : MMJ.

[14]  F. Bozorgi,et al.  Efficacy and Safety of Combination Therapy with Ketorolac and Morphine in Patient with Acute Renal Colic; A Triple-Blind Randomized Controlled Clinical Trial. , 2017, Bulletin of emergency and trauma.

[15]  P. Bigoniya,et al.  A Review on Epidemiology and Etiology of Renal Stone , 2017 .

[16]  Javad Seyedhosseini,et al.  Comparison of intranasal ketamine versus IV morphine in reducing pain in patients with renal colic , 2017, The American journal of emergency medicine.

[17]  R. Sud,et al.  Renal Stones: A Clinical Review , 2017, EMJ Urology.

[18]  F. Ziade,et al.  Effect of clonidine versus dexmedetomidine on pain control after laparoscopic gastric sleeve: A prospective, randomized, double-blinded study , 2014, Saudi journal of anaesthesia.

[19]  D. Gupta,et al.  The effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain after lower segment caesarean section: A randomized control trial , 2013, Saudi journal of anaesthesia.

[20]  James N. Campbell,et al.  Randomized control trial of topical clonidine for treatment of painful diabetic neuropathy , 2012, PAIN®.

[21]  R. Freeman,et al.  Diabetic Neuropathy , 2010, Diabetes Care.

[22]  M. Hidalgo,et al.  Preoperative anxiolytic effect of melatonin and clonidine on postoperative pain and morphine consumption in patients undergoing abdominal hysterectomy: a double-blind, randomized, placebo-controlled study. , 2009, The journal of pain : official journal of the American Pain Society.

[23]  Chih-Shung Wong,et al.  Epidural Clonidine for Postoperative Pain After Total Knee Arthroplasty: A Dose–Response Study , 2007, Anesthesia and analgesia.

[24]  C. Kalkman,et al.  The effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain and morphine requirements after Caesarean section: a randomized controlled trial. , 2006, British journal of anaesthesia.