Magnesium Sulfate Versus Lidocaine as an Adjunct for Renal Colic in the Emergency Department: A Randomized, Double-Blind Controlled Trial.

STUDY OBJECTIVE: We wished to determine whether the addition of magnesium sulfate (MgSO4) or lidocaine to diclofenac could improve the analgesic efficacy in emergency department (ED) patients with acute renal colic. METHODS: In this prospective, double-blinded, randomized controlled trial of patients aged 18 to 65 years with suspected acute renal colic, we randomized them to receive 75 mg intramuscular (IM) diclofenac and then intravenous (IV) MgSO4, lidocaine, or saline solution control. Subjects reported their pain using a numerical rating scale (NRS) before drug administration and then 5, 10, 20, 30, 60, and 90 minutes afterwards. Our primary outcome was the proportion of participants achieving at least a 50% reduction in the NRS score 30 minutes after drug administration. RESULTS: We enrolled 280 patients in each group. A 50% or greater reduction in the NRS score at 30 minutes occurred in 227 (81.7%) patients in the MgSO4 group, 204 (72.9%) in the lidocaine group, and 201 (71.8%) in the control group, with significant differences between MgSO4 and lidocaine (8.8%, 95% confidence interval [CI] [1.89 to 15.7], P=.013) and between MgSO4 and control (9.9%, 95% CI [2.95 to 16.84], P=.004). Despite this, differences between all groups at every time point were below the accepted 1.3 threshold for clinical importance. There were no observed differences between groups in the frequency of rescue analgesics and return visits to the ED for renal colic. There were more adverse events, although minor, in the MgSO4 group. CONCLUSION: Adding intravenous MgSO4, but not lidocaine, to IM diclofenac offered superior pain relief but at levels below accepted thresholds for clinical importance.

Piroxicam and paracetamol in the prevention of early recurrent pain and emergency department readmission after renal colic: Randomized placebo-controlled trial.

OBJECTIVE: Renal colic (RC) is a common urologic emergency often leading to significant pain and recurrent hospital visits. This study aimed to compare the efficacy and safety of piroxicam versus paracetamol in preventing pain recurrence and hospital readmission in patients treated for RC and discharged from the emergency department (ED). METHODS: A prospective, randomized, single-blind trial was conducted in four EDs. Eligible adults with RC were randomized to receive oral piroxicam, paracetamol, or placebo for 5 days post-ED discharge. Primary outcomes included pain recurrence and ED readmission within 7 days. Secondary outcomes included time to recurrence and treatment-related side effects. RESULTS: Of 1383 enrolled patients, no significant differences were observed among the groups regarding baseline characteristics. Pain recurrence rates within 7 days were 29% (95% confidence interval [CI] 24.9%-33.2%) for piroxicam, 30.3% (95% CI 26.1%-34.5%) for paracetamol, and 30.8% (95% CI 26.6%-35.0%) for placebo, with no significant between-group differences (p = 0.84). Among patients experiencing recurrence, the majority encounter it within the initial 2 days following their discharge (86% in the piroxicam group, 84.1% in the paracetamol group, and 86% in the placebo group, respectively). ED readmission rates were similar across groups: 20.8% (95% CI 17.1%-24.5%) in the piroxicam group, 23.8% (95% CI 19.9%-27.7%) in the paracetamol group, and 22.9% (95% CI 19.1%-26.8%) in the placebo group (p = 0.52). The piroxicam group reported significantly higher adverse effects compared to others. CONCLUSIONS: Piroxicam and paracetamol did not demonstrate efficacy in preventing pain recurrence or ED readmission within the first week following RC treatment.

Value of Lung Ultrasound Sonography B-Lines Quantification as a Marker of Heart Failure in COPD Exacerbation.

Introduction: Identifying heart failure (HF) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can be challenging. Lung ultrasound sonography (LUS) B-lines quantification has recently gained a large place in the diagnosis of HF, but its diagnostic performance in AECOPD remains poorly studied. Purpose: This study aimed to assess the contribution of LUS B-lines score (LUS score) in the diagnosis of HF in AECOPD patients. Patients and methods: This is a prospective cross-sectional multicenter cohort study including patients admitted to the emergency department for AECOPD. All included patients underwent LUS. A lung ultrasound score (LUS score) based on B-lines calculation was assessed. A cardiac origin of dyspnea was retained for a LUS score greater than 15. HF diagnosis was based on clinical examination, pro-brain natriuretic peptide levels, and echocardiographic findings. The LUS score diagnostic performance was assessed by receiver operating characteristic (ROC) curve, sensitivity, specificity, and likelihood ratio at the best cutoffs. Results: We included 380 patients, mean age was 68±11.6 years, sex ratio (M/F) 1.96. Patients were divided into two groups: the HF group [n=157 (41.4%)] and the non-HF group [n=223 (58.6%)]. Mean LUS score was higher in the HF group (26.8±8.4 vs 15.3±7.1; p<0.001). The mean LUS score in the HF patients with reduced LVEF was 29.2±8.7, and was 24.5±7.6 in the HF patients with preserved LVEF. LUS score area under ROC curve for the diagnosis of HF was 0.71 [0.65-0.76]. The best sensitivity (89% [85.9-92,1]) was observed at the threshold of 5; the best specificity (85% [81.4-88.6]) was observed at the threshold of 30. Correlation between LUS score and E/E' ratio was good (R=0.46, p=0.0001). Conclusion: Our results suggest that LUS score could be helpful and should be considered in the diagnostic approach of HF in AECOPD patients, at least as a ruling in test.