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Intranasal ketamine versus intravenous morphine for pain management in patients with renal colic: a double-blind, randomized, controlled trial



Urinary stones are a common urologic problem that can be manifested as an intense pain, known as renal colic. Pain control is an important intervention for the emergency treatment of renal colic patients. Intranasal ketamine can form a crucial part of such interventions by offering a new route for a widely-used analgesic drug.


In a double-blind, randomized, clinical trial, adults with renal colic admitted to a tertiary hospital emergency department were examined. The intervention group received 1 mg/kg intranasal (IN) ketamine and 1 ml of saline as a placebo. The control group received 0.1 mg/kg intravenous (IV) morphine and four puffs of saline as the placebo. The pain score was measured on the Numerical Rating Scale (NRS) 0, 15, 30 and 60 min after the drug administration.


A total of 184 patients enrolled in this study in two parallel groups. The two groups did not differ significantly in terms of pain intensity at the time of their referral (P = 0.489), 15 min post-dose (P = 0.204), 30 min post-dose (P = 0.978) and 60 min post-dose (P = 0.648).


IN ketamine is as effective as IV morphine for pain control in renal colic patients. No remarkable side-effects were observed for IN ketamine use in these patients.

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The authors wish to express their gratitude to all those who participated in this study and also all the data collectors, supervisors and administrative staff of the Emergency Medicine Department of Imam Reza Hospital affiliated to Tabriz University of Medical Sciences in Tabriz, Iran. This article was written based on a dataset by Zahra Vand Rajabpour’s speciality thesis entitled “Intranasal ketamine versus intravenous morphine for pain management in patients with renal colic: A double-blind, randomized, controlled trial”, approved by Tabriz University of Medical Sciences (IR.TBZMED.REC.1398.006) and presented in 2019.


This article was supported by the Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran. Special gratitude is expressed to the Vice Chancellor of Research of Tabriz University of Medical Sciences for all the material and financial support provided for this study.

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All the authors have read and approved the manuscript. MP, ZVR and HS were responsible for data collection, literature review, and drafting the manuscript. PM and SPP undertook major parts of the study design and performed the statistical analysis.

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Correspondence to Hassan Soleimanpour.

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The authors declare that they have no competing interests.

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The study was approved by the Ethics Committee of Tabriz University of Medical Sciences and registered under the code IR.TBZMED.REC.1398.006.

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Pouraghaei, M., Moharamzadeh, P., Paknezhad, S.P. et al. Intranasal ketamine versus intravenous morphine for pain management in patients with renal colic: a double-blind, randomized, controlled trial. World J Urol 39, 1263–1267 (2021).

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  • Ketamine
  • Morphine
  • Kidney stones