Intramuscular ketorolac prevents severe renal colic after stent removal

Intramuscular administration of ketorolac before stent removal is not effective in substantially easing pain experienced after removal relative to placebo, but it does lower the likelihood of severe renal colic that warrants emergency department or office visits, reports a recent study.

“Eligible patients may benefit from routine use of ketorolac injection at the time of stent removal,” the researchers said.

This prospective, randomized, double-blind, placebo-controlled trial assessed the effects of ketorolac administered at time of stent removal. The researchers randomly assigned 124 patients to receive an intramuscular ketorolac 30 mg (n=62) or placebo (n=62) immediately prior to stent removal. They contacted the patients 1 and 7 days following stent removal to evaluate pain, need for opioids, emergency department or clinic visits, and need for surgical or medical interventions.

Both groups had similar demographic/operative characteristics. No between-group difference was noted in mean pain scores or proportion of patients who experienced severe pain at 1 and 7 days after stent removal. However, use of ketorolac led to markedly fewer renal colic-related unplanned emergency department/clinic visits in the treatment group compared with the control group (2 percent vs 13 percent; p=0.032).

“The treatment of stones ureteroscopically is associated with postoperative pain, thought to be due largely to the use of ureteral stents,” the researchers said. “In some, stent removal precipitates renal colic that can last from minutes to hours.”