Category: Professional Posters
Purpose: Renal colic presents as acute radiating pain from the flanks to the groin, accompanied by microscopic hematuria, nausea and vomiting. Pain occurs due to the passage of a stone from the ureter due to obstruction of the urinary flow, increased pressure on the urinary tract wall, inflammation and edema. In light of the opioid crisis, the emergency department providers are committed to consider alternative pain management approaches.
Methods: Historically, non-steroidal anti-inflammatories and opioid are used for these patients. Research has demonstrated that IV lidocaine can be effective to treat patients suffering from acute renal colic but no guidelines existed to safely administer IV lidocaine for acute renal colic in a community hospital. A literature search was conducted to identify studies utilizing IV lidocaine for pain management both in the emergency department and post-surgical pain. Studies looking at the effectiveness of lidocaine IV for the treatment of pain, and more specifically acute renal colic, studies whose primary endpoint included an evaluation of the safety of administration in an emergency room setting were also evaluated. At this time a decision was made to limit our implementation to the treatment of renal colic as the literature for other pain management indications did not demonstrate the same efficacy. Once the studies were identified, an analysis of dosing, frequency and monitoring perimeters were reviewed and a dosing strategy was determined with consultation with the emergency room physician champion. IV infusion rates, contraindications and maximum doses were all determined by literature review. The emergency room nurse educator was consulted for nursing care parameters. These instructions included the recommendation of a 12 lead EKG prior to infusion, and observation and monitoring parameters. Education was developed for the nursing staff to safely administer IV lidocaine to patients with renal colic.
Results: As a result, 88 patients presented to the emergency department with the diagnosis of renal colic, only 7 had documented contraindications to IV lidocaine. 81 patients who were eligible for IV lidocaine received treatment with non-steroidal anti-inflammatory agents, and 2 of those patients were treated with IV lidocaine after failing ketorolac and morphine administration. No cardiac or other toxicity related adverse effects were identified, and patient’s pain was satisfactorily controlled.
Conclusion: In conclusion, it has been demonstrated that a safe and effective program can be developed to administer IV lidocaine to patients in a community hospital emergency room. Increased physician education should be utilized to increase the awareness of IV lidocaine as a treatment alternative to patients who present with a diagnosis of renal colic.