Kidney Stone Pain

[ERDoc]

This has been discussed pretty extensively in the literature (I'll leave the literature search up to you). NEVER withold pain medications even in abd pain pts. Giving narcotics DOES NOT make your physical exam (or the physician's) less accurate. If fact, it has been shown to make it more accurate (again, I'll leave it to you to do the literature search). Toradol and morphine work pretty well together along with your antiemetic de jour. The way I approach kidney stones is to scan all first time stones with CT, UA and depending on how long the pain has been going on for I'll check a chemistry. In those with a history of stones that they have been able to pass on their own I'll skip the testing and treat the pain. Flomax has been shown to help move the stones along so they'll get a few days of it (though some recent studies are questioning this).

Someone brought up migraines so let's talk about them a little. Narcotics are towards the bottom of the list. They are notorious for causing rebound migraines. Unfortunetly in my area anyone that mentions the word pain gets 2mg Dilaudid and 25mg of Phenergan. This is probably why we have so many seekers here (but that is for a whole other thread). For people with true migraines toradol, benadryl, compazine/phenergan +/- solumedrol usually does the trick. If they need more I will give an additional dose of benadryl, compazine and a small dose of morphine (about 2mg). I will also give large fluid boluses. There has been some promise in intranasal lidocaine or bupivicaine but more needs to be done.

[chbare]

Provided no renal impairment exists, toradol can be very effective for renal colic.

Take care,

chbare.

[ERDoc]

One thing to remember about MS is that it's a great diuretic and may help flush out a stone. I know my Urologist gives low dose MS along with higher dose Demerol in-house.

Since when did morphine cause diuresis?? If anything it has just the opposite affect and causes increased ADH production.

[chbare]

Actually, many narcotics can cause both urinary retention and constipation. Good point ERDoc.

The fentanyl debate is two sided imho. I think it is a good choice in the EMS world because of hemodynamic stability and short duration of action. In the hospital, it is sometimes nice to have access to longer acting meds.

Take care,

chbare.

[Dustdevil]

Giving narcotics DOES NOT make your physical exam (or the physician's) less accurate.

Unless you inadvertantly gork them. :oops:

Anyhow, another vote here for ketorolac. I have had phenomenal results with it for nephrolithotic pain. Nothing more satisfying than giving a patient a shot for the worst pain of their life, and have them praise you as the best doc in the world half an hour later.

[HellsBells]

Someone brought up migraines so let's talk about them a little. Narcotics are towards the bottom of the list.

ERDoc, what is your opinion on using maxeran (Metoclopramide) for the treatment of migraines? I get the odd nasty migraine, and my doc has given me an Rx for maxeran, but I haven't had the need to try it yet.

[JPINFV]

But MRI and x-rays needed to confirm stones and not other kidney function problems. One argument is that stones need to be absolutely confirmed and you can't do that in the field prior to any meds. given.

I guess it's too bad that narcs shouldn't affect an imaging study.

[aussiephil]

one drugs we use here for that is methoxyflurane, it is an anasthetic that breaks throught the pain & allows other drugs to work.

Having suffered from stones myself, I know it works & works better than most other drugs for that problem.

The only other is Buscopan, an anti spasmodic agent that most will not carry prehospital.

Phil

[1EMT-P]

Personally I don't like to use narcotics for kidney stone pain. I like to use IM or IV Toradol with Phenergan.

[ladybear]

I'm lucky Toradol works for me both for kidney stones and migraines. I happen to be one of those lucky folk who has allergic reactions to the majority of narcotic medications. Toradol and Phenergan have been a blessing for me.

I can't speak for others, but I'm personally a little skeptical about Fentanyl mainly because when I was being treated for a possible ruptured appy they tried it on me and it didn't do a thing for my pain, just made me more nauseated.

I've passed four stones in the last year. The last one was while I was at work. Thankfully I was able to get through without any meds, however I wouldn't want to have to do that again. One of my co-workers said I was pretty pale for a bit....geeze I wonder why.