Thank you to Tony Seupaul, MD, chairman of the department of emergency medicine at the University of Arkansas at Little Rock, and Rachel Littlefield, MD, who is an emergency medicine resident at the University of Arkansas, for their help with this review.
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ACEP Now: Vol 37 – No 05 – May 2018Remember to be skeptical of anything you learn, even if you heard it on the Skeptics’ Guide to Emergency Medicine.
References
- O’Connor A, Schug SA, Cardwell H. A comparison of the efficacy and safety of morphine and pethidine as analgesia for suspected renal colic in the emergency setting. J Accid Emerg Med. 2000;17(4):261-264.
- Dave C, Faraj K, Shetty S. Nephrolithiasis. Medscape web site. 2017. Accessed April 12, 2018.
- Furyk JS, Chu K, Banks C, et al. Distal ureteric stones and tamsulosin: a double-blind, placebo-controlled, randomized, multicenter trial. Ann Emerg Med. 2016;67(1):86-95.e2.
- Ferrini RA, Paice JA. How to initiate and monitor infusional lidocaine for severe and/or neuropathic pain. J Supportive Oncol. 2004, 2:90-94.
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One Response to “Should You Use Lidocaine Instead of Opioids to Treat Renal Colic?”
May 27, 2018
Mark Mosley MDThis is only an important question to ask if you believe that giving opioids to a low risk opioid naive patient with objective symptoms somehow increases the odds of chronic opioid use or misuse.
The post-op surgical literature on opioid naive patients that does NOT screen out high risk patients (mental illness, smoking, alcohol, etc) finds that chronic use from opioid administration is 0.2 percent (close to zero).
So if you have a low risk patient with a kidney stone, give the poor soul whatever it takes to quickly, effectively, and safely make them better (this will likely include opioids in many real deal stones).
If you have a patient at high risk for opioid misuse (chronic pain, addiction including nicotine, psychiatric disease including depression and anxiety, or electronic pharmacy records indicating excessive scripts, then we should be comparing non-opioid medications (toradol versus lidocaine).
Not sure why the opioid crisis has put all of our patients into a one-size-fits-all category of always starting with a non-opioid approach?