Rodrigues, João Paulo Machado

Background and importance Renal colic pain is typically managed using intravenous opioids, but the intranasal route has emerged as a less invasive and time-efficient alternative. Intranasal ketamine has shown promise as a safe and effective analgesic for acute pain in emergency settings. Objective To compare the efficacy and safety of intranasal ketamine versus intravenous opioids for renal colic pain management in the emergency department. Design, settings, and participants PubMed, Embase, and Cochrane were systematically searched for randomized controlled trials (RCTs) comparing intranasal ketamine to intravenous morphine or intravenous fentanyl in patients with renal colic. Intervention or exposure Intranasal ketamine as the primary intervention; comparators were intravenous morphine or fentanyl. Outcomes, measure, and analysis The primary outcome was pain intensity at various time points, measured using the Visual Analog Scale (VAS) and Numerical Rating Scale (NRS). Secondary outcomes: need for rescue analgesia, incidence of adverse events, nausea, and dizziness. Data were pooled using random-effects models to calculate mean differences for continuous outcomes and risk ratios for binary outcomes, with 95% confidence intervals (CIs). All statistical analyses were performed using R Software, version 4.2.3. Main results We included four RCTs, involving 454 patients, of whom 230 (50.6%) received intranasal ketamine. There were no significant differences between groups in pain scores at 5 min (mean difference: −0.41 VAS/NRS, 95% CI: −1.88 to 1.07, P = 0.59), 15 min (mean difference: −0.20 VAS/NRS, 95% CI: −0.86 to 0.46, P = 0.56), and 30 min (mean difference: 0.53 VAS/NRS, 95% CI: −0.08 to 1.13, P = 0.09). No significant differences were found between groups in the need for rescue analgesia or in the incidence of adverse events, nausea, or dizziness. Conclusion Intranasal ketamine demonstrated analgesic efficacy comparable to intravenous opioids at 5, 15, and 30 min, with no increase in adverse events or rescue analgesia requirements.