Background: The EAU (European Association of Urology) guidelines on diagnosis and conservative management of urolithiasis state that the pain relief should be the prime step and NSAIDs (Non-steroidal anti-inflammatory drugs) should be the first line of analgesia then come narcotic analgesics and alpha blockers should for medical expulsive therapy. The patients presenting to emergency department with renal colic often are in distress due to severe nature of pain, thus analgesia should be initiated promptly and preferably NSAIDs like ketorolac. Spasmolytic drug like drotaverine can be used effectively to relieve the smooth muscle spasm of the urinary tract due to presence or passage of stone. This study will evaluate the role of combination therapy of ketorolac (which is a preferred NSAID as analgesic drug) and the drotaverine (which is a spasmolytic drug whose efficacy has been widely tested in gynaecologic field) against ketorolac only in renal colic patients presenting to emergency. Method: It was a randomised controlled trial consisting of two groups. Group A (n=73) was received a combination therapy of ketorolac and drotaverine whereas group B (n=73) was received ketorolac only. Visual analogue scale was utilised for assessing the pain score at arrival and 30, 60 and 120 minutes after the administration of the drug and decrease of two or more points were considered effective in relieving pain on VAS. Conclusion: Renal colic was one of the most common presentations of acute pain in emergency, the priority should be given to manage the acute pain episode focusing on measures to decrease the severity of pain. Ketorolac which is a non-steroidal anti-inflammatory drug and has a proven efficacy in decreasing the pain not only by inhibiting the formation of pain mediators but it also minimizes the GFR leading to decreased intrarenal pressure. Drotaverine is phosphodiesterase type IV inhibitor with mild calcium channel blocking effects and it has minimal or no anticholinergic effects. The combination therapy with both ketorolac and drotaverine proved to have greater efficacy in reducing the pain intensity thus exhibiting effective pain regimen and reduced dissatisfaction in patients with renal colic. As studies proved that pain remains undertreated in emergency department. This study was identifying the effectiveness of combined therapy of drotaverine with ketorolac as compared to monotherapy with ketorolac alone in emergency management of renal colic.

Keywords: Renal colic, Ketorolac, Drotaverine, Non-steroidal anti-inflammatory drug.

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