Role of Papaverine Hydrochloride Administration in Patients With Intractable Renal Colic: Randomized Prospective Trial

Objectives: To evaluate the therapeutic effect of papaverine hydrochloride in the treatment of patients with renal colic pain unresponsive to conventional treatment. Methods: From March 2007 to January 2008, a total of 561 patients with severe renal colic pain due to a ureteral stone were treated with conventional agents (hyoscine-N-butylbromide and diclofenac sodium) in the emergency and urology departments. Of these 561 patients, 110, with no response to the treatment and persistent severe pain, were randomized into 3 groups for additional treatment. The patients in group 1 (n = 37) received intravenous hyoscine-N-butylbromide, those in group 2 (n = 37) received papaverine hydrochloride, and those in group 3 (n = 36) received pethidine. Before and after treatment, all patients completed a visual analog scale (VAS) questionnaire, with a scale of 0 (no pain) to 10 (maximal complaint), to measure their subjective pain. The mean VAS score of each group was compared with that of the other groups. Results: The pretreatment mean VAS scores of all 3 groups were not significantly different statistically from each other (4.02 ± 1.20, 4.36 ± 1.97, and 4.27 ± 1.50; P > .05). However, after treatment, the mean VAS scores of the patients treated with papaverine (0.93 ± 0.29) and pethidine (0.81 ± 0.38) were significantly different from those of the hycosine group (3.67 ± 2.21; P < .001). However, the mean VAS scores of groups 2 and 3 were comparable (P = .67). Unlike opioids, no papaverine-related severe side effects were observed. Conclusions: Our results indicate that papaverine hydrochloride can used in an effective manner in the management of renal colic pain in patients unresponsive to commonly used conventional agents. © 2008 Elsevier Inc. All rights reserved.