(1033) Intravenous Lidocaine for Renal Colic Treatment in the Emergency Department

Introduction: Management of renal colic in the emergency department involves the utilization of opioids and nonsteroidal anti-inflammatory drugs (NSAIDs). Renal colic denotes acute severe pain linked with obstruction of the urinary tract by ureteral calculi. The Centers for Disease Control and Prevention 2022 clinical practice guidelines for prescribing opioids for pain advocate for a multimodal approach to pain control. Lidocaine, a voltage gated sodium channel blocker, may offer an alternative mechanism for pain relief. Typical dosing for this indication is 1.5 mg/kg IV with a maximum dose of 200mg. The purpose of this study was to ascertain the effect of intravenous lidocaine on opioid requirement and pain control in patients with renal colic in the emergency department. Intravenous lidocaine has been employed for pre-operative and post-operative pain owing to its anti-nociceptive, anti-inflammatory, and anti-hyperalgesic mechanism.

Methods: Evaluation was conducted through a retrospective cohort analysis in patients who received analgesics for renal colic in the emergency departments at University Hospitals Systems. Inclusion criteria encompassed patients with acute renal colic and ureteral calculi diagnosed on computed tomography or ultrasound. Exclusion criteria included pregnancy. Patients were segregated into two cohorts based on administered analgesic regimens for renal colic: standard of care and standard of care plus intravenous lidocaine. The primary endpoint was the difference in morphine equivalence.

Results: This cohort analysis included 126 patients. The difference in average morphine equivalence for patients receiving standard of care was 20.4 MME compared to 21.3 MME in the lidocaine plus standard of care group (p=0.617). Inpatient admission occurred in 15/89 patients, and 8/37 in the lidocaine and standard groups respectively. Safety events were not documented.

Conclusions: There was no statistically significant difference in morphine equivalence between standard of care analgesics and standard of care in addition to intravenous lidocaine administration groups.