# Comparison of the Analgesic Effect of Ketamine and Midazolam with Paracetamol (Acetaminophen) and Ketorolac in Renal Colic Patients: A Clinical Trail: Comparison of the Ketamine and Midazolam with Paracetamol and Ketorolac

## TL;DR

This study compares two drug combinations for pain relief in patients with kidney stone pain and finds that Ketamine and Midazolam work better than Acetaminophen and Ketorolac.

## Contribution

The study provides new evidence that Ketamine and Midazolam are more effective for acute pain management in renal colic compared to standard analgesics.

## Key findings

- Ketamine + Midazolam reduced pain more effectively than Acetaminophen + Ketorolac at all measured time points.
- Both drug combinations significantly decreased pain over time, but Ketamine + Midazolam showed superior analgesic effects.
- The study supports using Ketamine + Midazolam when standard analgesics are not suitable for renal colic patients.

## Abstract

Renal colic is the most prevalent symptom of urinary stones, and it is quite
painful. This study aimed to determine the effect of the Ketamine and
Midazolam combination and compare it with the acetaminophen (paracetamol or
Apotel) and Ketorolac (Toradol) combination in pain management of patients
with renal colic in the emergency department (ED).

In this double-blind clinical trial study, 200 renal colic patients admitted
to the ED with more than 8 Numeric Rating Scale (NRS) of primary pain were
divided into two groups by random blocking: one group received intravenous
Ketamine (0.4 mg/kg), and intravenous Midazolam (at a dose of 0.016 mg/kg)
and the other group received intravenous Ketorolac (30 mg) and intravenous
acetaminophen (15 mg/kg). After that, we measured patients’ pain by NRS at
1, 5, 10, 15, 30, and 45 min after the procedure. The data were analyzed
using IBM SPSS 21.0 software.

124 (62.0%) of 200 patients were men. Initial pain scores were 9(10-9) for
Ketamine + Midazolam and 10(10-9) for Acetaminophen + Ketorolac.Linear
regression was performed to compare the two groups’ adjusted pain scores,
correcting for initial pain. The ultimate pain score increased by.392 units
for each unit of starting pain. Group and time had significant effects
(5.553, -.035, P=.001, respectively). Acetaminophen + Ketorolac had a higher
mean pain score than Ketamine + Midazolam at all post-intervention time
intervals. During the trial, both groups’ discomfort decreased
significantly.

The combination of Ketamine and Midazolam was more effective than
Acetaminophen and Ketorolac in relieving the pain in renal colic. Therefore,
if routine medications are contraindicated, a combination of Ketamine and
Midazolam is recommended for pain control in patients with renal colic.