Efficacy of Intravenous Lidocaine Versus Ketorolac for Acute Pain Relief in Patients With Suspected Renal Colic Presenting to the Emergency Department at Pakistan Ordnance Factories (POF) Hospital, Wah Cantt, Pakistan

Background: Renal colic is a common urological emergency requiring prompt and effective analgesia. Although intravenous ketorolac is recommended as first-line therapy, its use may be limited in patients with contraindications to non-steroidal anti-inflammatory drugs (NSAIDs). Intravenous lidocaine has emerged as a potential non-opioid alternative. This study compared the analgesic efficacy and short-term safety of intravenous lidocaine with intravenous ketorolac in adults presenting with suspected renal colic. Methods: This prospective, single-center, randomized controlled trial included 90 adults presenting to the emergency department with suspected renal colic and a Visual Analogue Scale (VAS) pain score of ≥7. Participants were randomly assigned to receive either intravenous lidocaine (1.5 mg/kg infused over 15 minutes; n = 45) or intravenous ketorolac (30 mg intravenous bolus; n = 45). The primary outcome was successful pain relief, defined as a reduction of at least three points on the VAS 30 minutes after treatment. Secondary outcomes included rescue analgesia requirements and adverse events. Results: Successful pain relief was achieved in 31 patients (68.9%) in the lidocaine group and 27 patients (60.0%) in the ketorolac group (absolute risk difference 8.9%; 95% confidence interval, −10.8% to 28.6%; χ²(1) = 0.776, p = 0.378). Rescue analgesia was required in 14 patients (31.1%) receiving lidocaine and 18 patients (40.0%) receiving ketorolac. Adverse events were infrequent and mild, with transient dizziness reported in three patients receiving lidocaine and mild hypersensitivity reactions in two patients receiving ketorolac. No serious adverse events occurred. Conclusions: Intravenous lidocaine provided analgesic efficacy comparable to intravenous ketorolac for the management of suspected renal colic, with a similar short-term safety profile. Intravenous lidocaine may be considered a useful alternative for patients in whom NSAIDs are contraindicated or poorly tolerated. Larger multicenter studies are warranted to confirm these findings.