Background & Aims
This study shall describe how pain was managed among adult patients with renal colic in the emergency room of St. Luke’s Medical Center, Quezon City from January 2020 to June 2023.
Its General Objective is to evaluate the management of pain among patients diagnosed with ureteral
stones at the emergency department of St. Luke’s Medical Center- Quezon City
The specific objectives are to determine the specific types and combinations of pain medication used among patients with renal colic. To determine the turnaround time for renal colic patients to decrease pain rating scale by 2 points and to less than or equal to 4/10. Lastly, to determine the variables that caused the delay in pain control turnaround time
Methods
This is a cross sectional study whereby researchers collected and analyzed the pain medications used and pain control turnaround time quantitatively among patients diagnosed with ureterolithiasis in St. Luke’s Medical Center, Quezon City. Data collection encompassed the period of 42 months (January 2020 to June 2023). A total enumerative sampling was utilized in the collection of patient records.
Descriptive statistics was used analyzed using measures of central tendency to determine the frequency of the use of each pain medication and determination of pain management turn-around time to decrease pain severity to a numerical rating scale of less than 4/10
Prevalence odds ratio was also measured to determine the number of cases and the type of medication prescribed to the subjects.
The study also determined the measurement of frequency and percentage distribution of the patients who achieved pain relief within the turnaround time in correlation with the analgesics given to them.
Results
The Mann Whitney-U test showed that neither of the first two analgesics showed significant difference in the patients turnaround time. And when the third to seventh analgesics were given, the turnaround time was slowed down as the medications were administered at different schedules.
On the percentage distribution, it can be seen that as an initial analgesic, the use of Opioids alone and Opioids with Antispasmodics as combination drugs ended up to have the longest turnaround time. However, we also took note that patients who were given opioids had the highest pain scale upon presentation in the ED. With this data, the severity of pain can be seen as a confounding variable in this study. The use of NSAIDS and antispasmodics as initial drugs showed the shorter turnaround time, Also, when given together as a second line analgesic, it also resulted in the shortest turnaround time. This shows that multimodal analgesia in the treatment of acute pain is needed to hasten pain control.
Conclusions
Our studies suggest that in the treatment of patients suffering acute pain from Urolithiasis, the use of any of the drugs alone or combination (Tramadol, NSAIDS, Paracetamol, Antispasmodics or Muscle Relaxant) at the recommended dose did not allow to meet the standardized turnaround time set by our institution. Opiophobia has greatly limited the prescription of strong opioids among this patients
References
1.Lam, S. H., Homme, J., Avarello, J., Heins, A., Pauze, D., Mace, S., Dietrich, A., Stoner, M., Chumpitazi, C. E., & Saidinejad, M. (2021). Use of antitussive medications in acute cough in young children. Journal of the American College of Emergency Physicians Open, 2(3). https://doi.org/10.1002/emp2.12467
2.Vogelberg, C., Cuevas Schacht, F., Watling, C. P., Upstone, L., & Seifert, G. (2023). Therapeutic principles and unmet needs in the treatment of cough in pediatric patients: Review and expert survey. BMC Pediatrics, 23(1). https://doi.org/10.1186/s12887-022-03814-0
3.Waring, G., Kirk, S., & Fallon, D. (2019). The impact of chronic non-specific cough on children and their families: A narrative literature review. Journal of Child Health Care, 24(1), 143–160. https://doi.org/10.1177/1367493518814925
4.Bonnes, J., & Meyers, G. (2020). What is the efficacy of OTC antitussives for children with a viral URI? Evidence-Based Practice, 23(4), 20–21. https://doi.org/10.1097/ebp.0000000000000611
5.Cross, A. L. (2022, November 14). Pregabalin. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470341/
6.Pregabalin. (n.d.). https://www.bionity.com/en/encyclopedia/Pregabalin.html
7.Chan, P. L. S., Marshall, S. F., McFadyen, L., & Liu, J. (2021, July). Pregabalin population pharmacokinetic and exposure-response analyses for focal onset seizures in children (4-16 years) and adults, to support dose recommendations in children. Clinical pharmacology and therapeutics. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8359225/
8.Model-informed drug development in pediatric dose selection. (n.d.). https://accp1.onlinelibrary.wiley.com/doi/10.1002/jcph.1848
9.Al-Biltagi, M., Bediwy, A. S., & Saeed, N. K. (2022). Cough as a neurological sign: What A clinician should know. World Journal of Critical Care Medicine, 11(3), 115–128. https://doi.org/10.5492/wjccm.v11.i3.115
10.Li, J., & Ye, L. (2019). Effect of pregabalin for the treatment of chronic refractory cough. Medicine, 98(23). https://doi.org/10.1097/md.0000000000015916
11.Decoster, L., Van der Goten, A., Eerens, I., Goffin, K., & De Rycke, A. (2019). A rare cause of chronic cough. Thorax, 74(5), 521–522. https://doi.org/10.1136/thoraxjnl-2018-212435
Presenting Author
Rosalee E. Gonzales
Poster Authors
Rosalee Gonzales
MD
St. Luke's Medical Center Quezon City
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Visceral Pain – Gastrointestinal/Abdominal