Does Magnesium Sulfate Boost Pain Relief in Renal Colic?

TOPLINE: 

The addition of magnesium sulfate to diclofenac provides superior pain relief to that provided by diclofenac alone in emergency department patients with acute renal colic, but the added benefit does not reach clinical significance.

METHODOLOGY:

• Researchers conducted a prospective, double-blind, randomized clinical trial from November 2022 to August 2023 that enrolled 840 adults (aged 18 to 65 years) with suspected acute renal colic and a self-reported pain score of ≥ 5 on the numerical rating scale (NRS) who visited the emergency departments of three academic hospitals in Tunisia.
• All participants received intramuscular diclofenac, following which they were randomly allocated to receive either magnesium sulfate (n = 280), lidocaine (n = 280), or normal saline (n = 280).
• The primary outcome was the proportion of participants achieving at least a 50% reduction in the NRS score 30 minutes after drug administration.

TAKEAWAY: 

• Overall, 227 (81.7%), 204 (72.9%), and 201 (71.8%) patients in the magnesium sulfate, lidocaine, and control groups, respectively, achieved at least a 50% reduction in NRS at 30 minutes.
• However, the differences in pain scores observed among the three groups did not meet the threshold for clinical importance (≥ 1.3) at any time point.
• The need for rescue analgesia was reduced with magnesium sulfate, but there was no difference in the number of return visits to the emergency department for recurrent renal colic.

IN PRACTICE:

“Considering its efficacy and relatively minor side effects, MgSO4 [magnesium sulfate], appears to be a suitable adjuvant analgesic treatment and could be considered with IM NSAIDs [intramuscular non-steroidal anti-inflammatory drugs] as a first-line combination for managing renal colic. The use of MgSO4 in emergency settings may be a cost saving alternative in many hospitals in middle-income countries,” the authors concluded.

SOURCE:

The study, led by Marwa Toumia, MD, Monastir University, Monastir, Tunisia, was published online in Annals of Emergency Medicine.

LIMITATIONS: 

The study failed to obtain diagnostic imaging for all patients with suspected urolithiasis. Relying on ultrasonography instead of clinical judgement could have affected the accuracy of the diagnosis. Additionally, the study could not determine whether higher doses of lidocaine or magnesium sulfate might provide more favorable results.

DISCLOSURES:

The study was conducted without financial support. The authors declared no conflicts of interest relevant to this article. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.