Evaluation of the Clinical Efficacy of Intranasal Desmopressin Spray, Parenteral Diclofenac or Their Combination in the Treatment of Acute Renal Pain Caused by Urolithiasis

Objectives: To evaluate the efficacy of intranasal desmopressin compared with intramuscular diclofenac and combination of both in the treatment of acute renal pain caused by stone disease. Patients and methods: Ninety patients (51 males and 39 females) presented to our hospital emergency department (Al-Yarmouk Teaching Hospital/Baghdad/Iraq) with the diagnosis of acute renal pain caused by urolithiasis. They were randomized into three equal groups; group A received desmopressin 40 μg intranasally (4 puffs, each puff equivalent to 10 micrograms), group B received intramuscular diclofenac 75 mg and group C received both desmopressin and diclofenac. A visual analogue scale was used to assess the pain intensity in the 3 groups at baseline, 10, 20 and 30 min after drugs administration. Results: At presentation, the pain intensity was similar in all three groups. For patients in group A, the initial pain score was 9.5 then it declined to 5.2, 3.7 and 3.7 at 10, 20 and 30 minutes after administration of desmopressin, and for patients in group B, the initial pain score was 9.8 then became 4.6, 2.9 and 2.3 at 10, 20 and 30 minutes after diclofenac, while for patients in group C, the initial pain score was 9.7 then became 4.8, 2.6 and 2.2 at 10, 20 and 30 minutes after administration of desmopressin and diclofenac. Conclusion: 40 μg intranasal desmopressin sprays can be used to relieve pain in patients with acute renal pain either alone or combined with diclofenac.