Uso de antagonistas hi en el tratamiento sintomático del colico renal acompañado de nausea

Histamine 1 Receptor Antagonist in Symptomatic Treatment of Renal Colic Accompanied by Nausea: Two Birds With One Stone?
Erdal Yilmaza, , , Ertan Batislama, Turgut Denizb and Ercan Yuvanca
aFaculty of Medicine, Department of Urology, University of Kirikkale, Kirikkale, Turkey
bDepartment of Emergency Medicine, University of Kirikkale, Kirikkale, Turkey

Received 16 May 2008; 
accepted 25 August2008. 
Available online 11 October 2008.

Objectives
The pain-relieving efficacy of antagonists of histamine 1 (H1) receptors that are widely found in the ureter and that cause contractions in renal colic was presented in comparison with a placebo.
Methods
Eighty-six patients who presented to the emergency service because of renal colic accompanied by nausea, and who had urinary system stonesdetected were included in the study. The patients were separated into 2 groups by double-blind, random assignment. The 45 patients in group 1 received 50 mg intramuscular (IM) dimenhydrinate. The 41 patients in group 2 received 2 mL IM saline solution as a placebo. The visual analogous scale (VAS) values were detected at referral of the patients and at 10, 20, and 30 minutes of therapy to detectthe pain intensity. Verbal descriptive scale (VDS) was used for evaluation of nausea and vomiting before and after the therapy.
Results
VAS values were statistically quite low in group 1 at 10, 20, and 30 minutes of therapy. VDS scores were also statistically significantly low in group 1 at 30 minutes of treatment.
Conclusions
Dimenhydrinate, which is an ethanolamine group H1 receptor blocker,appeared to be effective compared with the placebo in relieving renal colic pain and nausea and vomiting symptoms in patients. Comparative studies with other analgesics will be useful for determining how to use this agent for analgesic purposes in renal colic.
Article Outline
Patients and Methods
Statistical Analysis
Results
Comments
Conclusions
References
Renal colic is 1 of the most severe formsof pain, and its diagnosis and treatment frequently take place in the emergency department. A person's chances of having renal colic at any time during his/her life has been reported as 1%–10%.1
The treatment in renal colic should aim first to relieve the obstruction to eliminate pain and then to maintain renal functions at a maximum level. Although morphine and pethidine were chosen as the firstchoice of treatment in renal colic in the past, parenteral nonsteroidal anti-inflammatory (NSAI) drugs were widely used from late 1970s as agents with proven efficiencies.[1], [2], [3], [4], [5] and [6]
According to the currently accepted view, renal colic management starts with NSAI drugs.[2] and [5] Other alternatives can be used if the colic persists. Application of NSAI drugs during and afterthe colic may reduce edema and facilitate spontaneous elimination of the stone, as well as preventing recurrence.[2] and [4] NSAI drugs may cause reactions such as gastrointestinal discomfort, hemorrhage, perforation, and extreme sensitiveness.7 In addition, its use with anticoagulants can lead to hemorrhagic diathesis, cerebrovascular hemorrhage, asthma, hypovolemia, and dehydration, and iscontraindicated in patients with an intermediate or advanced level of kidney disease.7
Narcotic analgesics should be used as the second choice in cases that do not respond to NSAI drugs, with atropin, because of their risk of increasing nausea and vomiting.[4] and [5] Pain relief is accomplished by raising the threshold of pain in the spinal cord level and by changing the way pain is perceived in thebrain. The narcotic analgesics may cause nausea, vomiting, constipation, and numbness, and at higher dosages, respiratory depression and hypotension. Tolerance and addiction may develop after long-term use.8
When renal colic cannot be prevented with medical precautions, the pain can be treated with a urethral catheter or by percutaneous nephrostomy to provide drainage.[3] and [6]
The presence of...