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Intravenous Lidocaine for Intractable Renal Colic Unresponsive to Standard Therapy

Sin, Billy PharmD, MBA, BCPS1,*; Cao, John PharmD Candidate2; Yang, David PharmD3; Ambert, Karen MD4; Punnapuzha, Sheena MD4

doi: 10.1097/MJT.0000000000000729
Therapeutic Challenges
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Clinical Features: Renal colic is defined as a flank pain radiating to the groin caused by kidney stones in the ureter (urolithiasis). Renal colic is a frequent cause of Emergency Department visits. Most renal colic cases present as acute distress and severe back and/or abdominal pain that require prompt treatment with analgesics.

Therapeutic Challenge: Nonsteroidal anti-inflammatory drugs and opioids are traditionally used for renal colic in the Emergency Department. This trend of practice is based on clinical experience and expert opinion. Consensus guidelines that provide evidence-based approach for the management of renal colic are limited. One consensus guideline from Europe provides a systematic approach for the management of pain with the use of nonsteroidal anti-inflammatory drugss and opioids. However, no guidance is provided on how to manage patients who do not respond to these agents.

Solution: Intravenous lidocaine 120 mg in 100 mL normal saline was infused over 10 minutes for pain management for intractable renal colic unresponsive to standard therapy. Three minutes after initiation of lidocaine infusion, the patient reported numeric pain rating scale 1/10. At 5 minutes, the reported numeric pain rating scale was 0/10 and remained for 60 minutes after initiation of lidocaine infusion. No adverse events were reported during or after the infusion, and no subsequent analgesia was required.

1Pharmacy Practice, LIU Pharmacy (Arnold and Marie Schwartz College of Pharmacy), The Brooklyn Hospital Center, Brooklyn, NY;

2Pharmacy Practice, LIU Pharmacy (Arnold and Marie Schwartz College of Pharmacy), Brooklyn, NY;

3Pharmacy Practice, LIU Pharmacy (Arnold and Marie Schwartz College of Pharmacy), The Brooklyn Hospital Center, Brooklyn, NY; and

4Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, NY.

Address for correspondence: Assistant Professor of Pharmacy Practice, LIU Pharmacy (Arnold and Marie Schwartz College of Pharmacy), Division of Pharmacy Practice, 1 University Plaza, New York, NY 11201. E-mail: billy.sin@liu.edu

The authors have no conflicts of interest to declare.

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