Comparison of Magnesium Sulfate And Opioids in The Management of Renal Colic Unresponsive to Non-Steroidal Anti-Inflammatory Drugs

Comparison of Magnesium Sulfate And Opioids in The Management of Renal Colic Unresponsive to Non-Steroidal Anti-Inflammatory Drugs | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of Magnesium Sulfate And Opioids in The Management of Renal Colic Unresponsive to Non-Steroidal Anti-Inflammatory Drugs Asmaa M. Al Kfafy, Ahmed A. Sabry, Marwan M. Hisham, Mohamed H. Ali This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7012120/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Renal colic is a distressing and recurrent condition frequently encountered in emergency departments. Opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) are the primary treatment options. Opioids are associated with concerns of drug dependency and side effects. Magnesium sulfate (MgSO4) has beenreported to have analgesic effects on reducing pain following major lumbar surgery and laparoscopic cholecystectomy. Moreover, studies have demonstrated the effectiveness of MgSO4 as an adjunct therapy in the management of renal colic patients. Objectives: This study aims to evaluate IV MgSO4 as an alternative to opioids for renal colic patients unresponsive to NSAIDs, assessing pain relief time, treatment failure, admission rates, and complications such as anaphylaxis and dependency. Materials and methods: This study included 116 renal colic patients at Alexandria Main University Hospital who did not respond to NSAIDs, defined as those with a pain score >6 after 30 minutes of 30 mg. The patients were divided into two groups: the Opioid Group, which received nalbuphine (0.1–0.2 mg/kg, up to 20 mg), and the MgSO4 Group, which received magnesium sulfate (50 mg/kg, up to 2000 mg). Treatment outcomes were assessed and compared at 30, 60, and 120 minutes to evaluate the effectiveness of both approaches. Results: This study revealed no statistically significant differences between the two groups in terms of pain scores, vital signs, hematological and urinefindings, or ultrasound and CT findings before and after treatment in terms of overall improvement in outcomes. Conclusion: MgSO4 is as effective as opioids in relieving acute renal colic pain in the ED, with fewer side effects. It can reduce pain while minimizing opioid use and related risks. Trial registration: The trial is retrospectively registered at the Pan African Clinical Trial Registry with the identification number for the registry PACTR202406502996650. Magnesium Sulfate Renal Colic Unresponsive to Nonsteroidal Anti-Inflammatory Drugs Figures Figure 1 Figure 2 INTRODUCTION Renal colic is a major clinical concern and is identified by abrupt and severe flank discomfort caused by obstruction of the urinary tract. The prevalence of renal colic has been increasing, affecting individuals across diverse demographics. Recent epidemiological studies highlight its increasing occurrence, with a substantial burden on healthcare systems globally. The intense pain caused by renal colic not only diminishes the quality of life for those affected but also leads to an increase in visits to the emergency department and hospital admissions. (1) NSAIDs are effective analgesics and anti-inflammatories, forming the cornerstone of renal colic management. They help alleviate pain and aid in the passage of urinary stones, but their use presents certain challenges. (2) A key challenge with NSAID therapy for renal colic is the variable response among patients. Some individuals experience insufficient pain relief despite receiving the optimal NSAID dosage. This variability highlights the need to understand the factors affecting NSAID effectiveness, such as stone size, composition, and individual differences in drug metabolism. (3) NSAIDs are not without adverse effects, with gastrointestinal issues such as peptic ulcers and bleeding being common. Patients on anticoagulants, those with cardiovascular conditions, or those with renal dysfunction may be at greater risk. This necessitates careful clinical decision-making to balance pain relief with minimizing the risk of adverse events, particularly in more vulnerable patient groups. (4) The reliance on NSAIDs for renal colic management raises concerns about potential drug resistance and reduced long-term effectiveness, particularly given the chronic and recurrent nature of the condition. This highlights the need to explore alternative analgesic options, such as magnesium sulfate and opioids, for patients who are resistant or intolerant to NSAIDs. Exploring new treatment options is essential for improving renal colic management and patient outcomes. (3) Nonresponsive Ness to treatment adds complexity to managing renal colic, requiring a better understanding of the underlying factors. Variations in drug metabolism and the diverse characteristics of kidney stones, such as size, composition, and anatomical differences, can impact the effectiveness of NSAIDs. This variability highlights the complexity of renal colic and emphasizes the need for personalized treatment approaches to improve outcomes. (5) The diagnostic challenge of identifying nonresponsive cases complicates clinical decision-making in renal colic patients. Pain assessment is largely subjective and relies on patient-reported outcomes, making it difficult to distinguish between inadequate NSAID response and the progression of the condition. A comprehensive approach, including imaging studies and ongoing clinical evaluation, is needed to address this challenge. The dilemma lies in balancing the urgency of providing effective pain relief with understanding the underlying factors contributing to nonresponsive Ness. (6) Nonresponsive Ness to treatment in renal colic patients extends beyond pain management, potentially leading to prolonged hospitalizations, higher healthcare costs, and a significant impact on patients' quality of life. This clinical challenge calls for a reevaluation of current treatment protocols and the exploration of alternative therapies to better address the needs of this patient group. (7) The identification of nonresponsive cases in the context of renal colic represents a critical phase in clinical management, requiring a nuanced and multidimensional approach. (8) Clinical assessment is the first step in identifying nonresponsive renal colic patients. Pain evaluation, which is primarily based on subjective patient reports, helps gauge NSAID efficacy. However, the subjective nature of pain and individual variations in pain thresholds make it challenging to establish a standard for nonresponsiveness. Clinicians must consider not only pain intensity but also the duration and frequency of pain episodes to assess treatment effectiveness accurately. (9) Imaging studies, such as ultrasound and CT scans, are crucial in identifying nonresponsive renal colic cases because they provide detailed information on the size, location, and composition of kidney stones. When NSAIDs are ineffective, imaging helps uncover potential causes, such as larger stones or anatomical abnormalities. However, imaging results must be interpreted carefully, integrating them with clinical parameters for a comprehensive and collaborative diagnostic approach. (10) The exploration of alternative approaches in the management of renal colic becomes imperative when faced with patients who exhibit resistance or inadequate response to NSAIDs. (11) Magnesium sulfate, which may influence the formation and growth of calcium oxalate crystals, a key component of many kidney stones, plays a role in the treatment of renal colic because of its role in neuromuscular transmission and smooth muscle relaxation by blocking NMDA receptor and activating adenylate cyclase enzymes, which can alleviate spasmodic pain. Additionally, it inhibits pain signals in the dorsal nucleus of the hypothalamus and prevents them from reaching the central nervous system. This dual action makes magnesium sulfate a potential option for addressing both the symptoms and the underlying causes of renal colic. (12) Opioids are another alternative for managing renal colic, especially when NSAIDs are ineffective. They provide pain relief by binding to specific receptors, such as DOP, KOP and MOP. While opioids are effective in pain management, their safety concerns and potential for addiction require careful consideration. In cases where NSAIDs are contraindicated or ineffective, opioids may be a viable option for pain relief in renal colic patients. (13) The management of renal colic poses difficulties in striking a balance between reducing side effects and providing efficient pain relief. Opioids, while effective, carry risks such as respiratory depression, constipation, and dependence, requiring careful consideration, especially for prolonged or recurrent use. (14) This highlights the dynamic nature of renal colic management and the ongoing pursuit of personalized, patient-centered treatment strategies. (15) The goal of this study was to improve clinical decision-making and outcomes in renal colic management by evaluating alternative treatment options. This study aimed to systematically compare the safety and effectiveness of magnesium sulfate and opioids in patients unresponsive to NSAIDs, contributing to the evolving understanding of optimal treatment strategies and enhancing clinicians' therapeutic options. Ethical consideration The research protocol received approval (7 September 2023) from the Ethics Committee of Alexandria University Faculty of Medicine (IRB No. 00012098 – FWA No. 00018699) before any research-related activity commenced. This statement confirms that all research activities, including human subjects, adhered to the Declaration of Helsinki and other ethical norms established by the Research Ethics Committee of Alexandria University Faculty of Dentistry. The trial is retrospectively registered (11 June 2024) at the Pan African Clinical Trial Registry with the identification number for the registry PACTR202406502996650 . PATIENTS AND METHODS The study included 116 patients with renal colic who presented to the Emergency Department of Alexandria Main University Hospital. Selection criteria for patients: Inclusion criteria: Age: 18 to 65 years Renal colic is clinically diagnosed Patients who do not respond to NSAIDs. Exclusion criteria: Cardiac or renal disease. Respiratory rate less than 12 breaths/minute. Systolic blood pressure was less than 100 mmHg. Hypersensitivity to opioids or magnesium sulfate. Pregnancy and lactation. NSAID hypersensitivity or salicylate hypersensitivity. Patients with neuromuscular diseases, such as myasthenia gravis. Gastrointestinal bleeding and gastric ulcers. Bronchial asthma, exacerbations and Aspirin-Exacerbated Respiratory Disease. Substance abuse and drug addiction. Methods of clinical assessment: All patients were evaluated through the following scheme: History taking and examination: Patient ID, age, sex, complaint, past medical history, past surgical history and aabdominal examination Vital signs, including respiratory rate, blood pressure, heart rate, capillary refill time and level of consciousness, were recorded according to the Glasgow Coma Scale (GCS). Risk scores: Visual Analogue Scale (16,17) Laboratory and radiological parameters, including CBC results and urea, creatinine and urine analyses Pelvic-abdomen US All patients who did not respond to NSAIDs (ketorolac tomethamine) (pain assessment score > 6 after 30 minutes after 1 dose of 30 mg) were allocated into two groups: The opioid group received nalbuphine (0.1–0.2 mg/kg). Maximum: 20 mg): in the case of persistent pain, the dose was administered once. The magnesium sulfate group received magnesium sulfate (50 mg/kg body weight, maximum: 2000 mg), which was administered once. Measurements: After 30, 60 and 120 minutes, both groups will be compared in terms of their outcomes according to the following: Time taken to relieve pain Complications related to the drugs. RESULTS Fifty-eight patients were allocated to each intervention. All patients in each group completed the follow up (Figure 1). Biodata: The two groups were age- and sex-matched, and there was no statistically significant difference in age or sex distribution between the two studied age groups (Table 1). Clinical evaluation There was no statistically significant difference in SBP between the two studied groups premedicated and post medication ( p =.776 and p =.880, respectively). Intragroup comparisons revealed that the SBP was significantly lower after medication than before medication in the Opioids Group and the Magnesium Sulfate Group ( p <.001 and p <.001, respectively) (Figure 2-A). There was no statistically significant difference in SBP between the two studied groups premedicated and post medication ( p =.847 and p =.872, respectively). Intragroup comparisons revealed that the DBP was significantly lower post medication than premedication in the Opioids Group and the Magnesium Sulfate Group ( p <.001 and p <.001, respectively) (Figure 2-B). Mean arterial blood pressure (MABP) was not statistically significantly different between the two groups before and after treatment ( p =.830 and p =.980, respectively). Intragroup comparisons revealed that MABP (mmHg) was significantly lower post medication than premedication in the Opioids Group and the Magnesium Sulfate Group ( p <.001 and p <.001, respectively) (Figure 2-C). H eart rate was not significantly different in terms of the HR between the two studied groups before and after medication ( p =.800 and p =.432, respectively). Intragroup comparisons revealed that the HR (beats/min) was significantly lower after medication than before medication in the Opioid Group and the Magnesium Sulfate Group ( p <0.001 and p <0.001, respectively). There was no statistically significant difference in the HR percentage change between the two studied groups ( p =.708) (Figure 2-D). Respiratory rate was not significantly different between the two groups premedicated and post medication ( p =.845 and p =.086, respectively). Intragroup comparison revealed that there was a statistically significant decrease in the respiratory rate (breaths/min) post medication compared with premedication in the Opioids Group and the Magnesium Sulfate Group ( p <.001 and p <.001, respectively) (Figure 2-E). SPO 2 was not significantly different in the SPO 2 between the two studied groups premedicated and post medicated ( p =.773 and p =.086, respectively). Intragroup comparisons revealed that there was no statistically significant difference in the SPO 2 post medication compared with the premedication values in the Opioids Group and the Magnesium Sulfate Group ( p =.074 and p =.854, respectively) (Figure 2-F). Laboratory analysis: There was no statistically significant difference in the haemoglobin, WBC, platelet, urea, creatinine, pH, or PCO 3 or HCO 3 levels between the two groups ( p =.505, p =.594, p =.691, p =.523, p =.691, p =.704, p =.938, p =.422, p =.650, and p =.883, respectively). Urine analysis: There was no statistically significant difference in Pus cells, RBCs or crystals in the urine between the two studied groups ( p =.426, p =.762 and p =.831, respectively). Pain assessment (Visual Analogue Scale (VAS)): There was no statistically significant difference in the VAS score between the two studied VAS groups at 30 minutes, one hour, and two hours post medication ( p =.926, p =.652, p =.534, and p =.324, respectively). The intragroup comparison revealed that the VAS score was significantly lower post medication than premedication in the Opioids Group and the Magnesium Sulfate Group ( p <.001 and p <.001, respectively). There was no statistically significant difference in the VAS percentage change (thirty minutes postmedication vs. premedication), (one hour post medication vs. premedication), or (two hours post medication vs. premedication) between the two studied groups ( p =.655, p =.567 and p =.310, respectively). All patients in the two study groups experienced severe pain before receiving medication. There was no statistically significant difference in the VAS score between the two study groups at thirty minutes, one hour, and two hours postmedication ( p =.685, p =.450 and p =.594, respectively) (Table 2). US findings: There was no statistically significant difference in the presence of gravel stones or hydronephrosis between the two studied groups ( p =.8336, p =.8336, and p =.84148, respectively). Among the hydronephrosis patients in the Opioid Group (n=20), 85.00% had mild hydronephrosis, and 15.00% had moderate hydronephrosis. Among the hydronephrosis patients in the magnesium sulfate Group (n=19), 84.21% had mild hydronephrosis, and 15.79% had moderate hydronephrosis. There was no statistically significant difference in the severity of hydronephrosis between the two studied groups. ( p =.9442) (Table 3) CT findings: In the Opioid Group, 8.62% of the patients underwent CT, whereas in the Magnesium Sulfate Group, 5.17% of the patients underwent CT. There was no statistically significant difference in CT performance between the two studied groups ( p =.717). There was no statistically significant difference in the presence of stones or hydronephrosis between the two study groups ( p =.40654 and p =.4654, respectively). Among the hydronephrosis patients in the Opioids Group (n=2), 50.00% had mild hydronephrosis, and 50.00% had moderate hydronephrosis, whereas all (100.00%) of the hydronephrosis patients in the Magnesium Sulfate Group (n=2) had mild hydronephrosis. There was no statistically significant difference in the severity of hydronephrosis between the two groups ( p =.25014) (Table 3). Outcome: In the Opioid Group, 17.24% of the patients did not improve, and 82.76% improved, whereas in the Magnesium Sulfate Group, 17.24% did not improve, and 86.21% improved. There was no statistically significant difference ( p =.61006). Disposition: In the Opioid Group, 96.55% of the patients were disposed to the outpatient department, and 3.45% were admitted, while 100.00% of the patients in the magnesium sulfate group were disposed to the outpatient department. There was no statistically significant difference in the improvement outcome between the two studied groups thirty minutes postmedication ( p =.15272). Complications: Complications were equal in both groups (1.72%). DISCUSSION Acute renal colic is a sudden and severe onset of flank pain that usually begins at the costovertebral angle and radiates to the groin or testis. Nausea and vomiting are frequently symptoms of this condition, which is frequently caused by an abrupt obstruction of the urinary tract by a stone. ( 18 ) Nonsteroidal anti-inflammatory drugs are the principal therapy for renal colicand function through two mechanisms: they diminish the synthesis of arachidonic acid metabolites, which stimulate pain receptors and alleviate the pain associated with renal capsule distension, and they cause the efferent arterioles to contract, thereby reducing the hydrostatic pressure across the glomerulus. ( 19 ) Opioids are commonly used in treatment protocols to relieve pain; however, two significant clinical issues are associated with their use. ( 20 , 21 ) The primary complication is drug dependency. The second obstacle is the variety of adverse effects that opioids can induce, such as shock, vomiting, apnea, respiratory arrest, and cardiac, blood pressure, and heart rate declines. ( 20 ) Consequently, it is imperative to identify novel medications that can alleviate acute renal distress. In this context, tocolytic drugs, including magnesium sulfate, may be beneficial. Magnesium chloride is effective. In the present study, no statistically significant differences in age or sex distributions were detected between the MgSO4 and Opioid groups. Ahmed et al. (2019) ( 22 ) assessed the efficacy of IV MgSO4 as an adjunctive therapy for the management of patients unresponsive to standard treatments (NSAIDs or opioids) due to acute renal colic and identified its ability to reduce the need for supplementary dosages of NSAIDs or opioids in the treatment of acute renal colic. There were no statistically significant changes in the age or sex distributions of the 96 patients in the trial, who were split into two groups of 48 each and ranged in age from 18–60 years. Jokar et al. (2017) ( 12 ) examined how MgSO4 affects the relief of acute renal colic pain. For the study, one hundred patients were gathered and split into two groups. 0.1 mg/kg IV MgSO4, 30 mg IV ketorolac, and 100 ml IV normal saline as a placebo were given over 15 minutes to patients in the first group as part of the conventional protocol. In addition to the usual procedure, the second group received an intravenous infusion of 15 mg/kg MgSO4 (50% solution) in 100 ml of normal saline for a period of 15 min. No instances of dizziness were reported in either group, and the study revealed no appreciable variations in the drowsiness, nausea, vomiting, or itching between the two groups. Furthermore, the control group received a considerably greater average amount of extra morphine than the MgSO4 group did (1.56 mg vs. 0.96 mg; p = .043). Our findings revealed that there was no statistically significant difference in the two SBP groups' vital signs (SBP, DBP, MABP, HR and SPO 2 ) before and after medication. In alignment with the present study results, Ahmed et al. (2019) ( 22 ) reported no significant differences in vital indicators, including SBP and DBP, HR, and RR, prior to the intervention or at 30 and 60 minutes postintervention. Moharari-Shariat et al. (2014) ( 23 ) reported no significant differences in pulse or respiratory rate following MgSO4 administration for relieving pain following major gastrointestinal nonlaparoscopic procedures. Sadrabad et al. (2021) ( 24 ) assessed the effectiveness of MgSO4 versus morphine sulfate in treating renal colic, highlighting the analgesic qualities of both and the absence of the side effects of morphine when MgSO4 is used. Following the delivery of the medicine, they discovered no discernible difference in the vital signs of the MgSO4 and morphine sulfate groups. Verki et al. (2019) ( 25 ) assessed the analgesic effects of MgSO4 on acute renal colic pain. The Group A patients were given standard treatment, which included 100 cc of IV normal saline as a placebo and 30 milligrams of IV ketorolac. Patients in Group B were given 50 mg/kg MgSO4 (50% solution) dissolved in regular saline. There were no discernible differences in the initial pain scores or demographic characteristics between the groups. Hemodynamic measures such as blood pressure, heart rate, respiratory rate, and oxygen saturation did not significantly change after the intervention and were similar between the two groups. In partial alignment with our findings, Jokar et al. (2017) ( 12 ) reported that the two groups' SBP and DBP, respiration rates, oxygen saturation, and body temperatures at different points in time did not differ significantly. Furthermore, the mean pulse rate of the MgSO4 group was noticeably lower than that of the conventional procedure group. The present study revealed no statistically significant difference in the VAS score between the MgSO4 group and the opioid group 30 minutespostmedication or one and two hours post medication. Ahmed. Et al. (2019) ( 22 ) demonstrated that after 30 minutes, the pain level of patients in the MgSO4 group, as determined by the, considerably improved. This suggests that there was a statistically significant difference in the research groups' levels of discomfort, with the MgSO4 group reporting more relief. the MgSO4 group reported significantly better pain alleviation than the control group did, indicating a statistically significant difference in pain severity between the study groups. Sadrabad et al. (2021) ( 24 ) reported that MgSO 4 was evaluated against standard treatments despite not being a traditional analgesic for relieving renal colic. Magnesium sulfate significantly reduced pain with few or no adverse effects, with efficacy comparable to that of morphine. At the time of referral, the two groups' demographic traits and level of pain were comparable. The mean pain score was 4.88 for the morphine group and 5.70 for the magnesium group ten minutes after the medicine was administered; the morphine group reported less pain ( p = 0.06). However, 20 minutes later, there was no discernible difference between the mean pain scores of the morphine and magnesium groups, which were 3.65 and 3.20, respectively ( p = .48). The timing of the action of magnesium sulfate may be the reason for the delayed reaction compared with that of morphine sulfate. Research has shown that the effects of MgSO 4 on pain relief are frequently evaluated at least one hour after delivery. ( 26 – 28 ) This delayed onset might account for the slower initial response than that of more immediate-acting analgesics such as morphine sulfate. This is the first study evaluating the efficacy of MgSO4 as a single-drug treatment for renal colic. Jokar et al. (2017) ( 12 ) reported a significant difference in pain severity on the VAS with the use of MgSO4. The study concluded that incorporating MgSO 4 into the standard treatment for renal colic has been shown to reduce pain severity and lower the need for additional morphine. MgSO4 can be used as an additional therapy for renal colic because it is easy to administer and has not been linked to any negative side effects. Additionally, combining MgSO 4 with other drugs may limit possible side effects and enable lower dosing. Majidi et al. (2020) ( 29 ) evaluated the effectiveness of MgSO 4 in treating renal colic pain in the emergency department. Ninety patients were randomly assigned to one of two equal groups and administered either morphine sulfate or MgSO 4 . The two groups' levels of pain were compared at different intervals, including when they were admitted to the emergency department and 20, 30, 60, 120, and 180 minutes after the medicine was administered. At each of these time points, there were no discernible changes in the groups' mean pain scores as determined by the. After 20 minutes, both groups had an identical success rate of reducing pain by at least 3 points on the VAS (91.1% each), and by 30 minutes, both groups achieved a complete reduction of 100%. At 20 minutes, a significantly greater number of patients in the morphine group were pain free (VAS score of 0) than those in the MgSO 4 group were (31 versus 16 patients, p = .004). After thirty minutes, the percentage of pain-free patients in both groups was similar (39 versus 29, p = .063). Jokar et al. (2017) ( 12 ) compared MgSO 4 and ketorolac in the management of renal colic pain and reported that MgSO 4 effectively reduced pain and minimized the need for supplementary morphine. Similarly, Kocman et al. (2013) ( 30 ) demonstrated that giving patients who underwent laparoscopic cholecystectomy a small dosage of MgSO 4 greatly reduced their pain. Chen et al. (2020) ( 31 ) performed a meta-analysis and systematic evaluation of four trials to evaluate the safety and effectiveness of MgSO 4 in treating renal colic in comparison with a control. By contrasting intravenous MgSO 4 with a control, every RCT that was part of the systematic review and meta-analysis evaluated the degree of pain experienced by individuals with renal colic. The meta-analysis revealed that MgSO 4 did not significantly reduce discomfort at 15, 30, or 60 minutes. The examination of restricted data from studies involving patients unresponsive to initial analgesic doses or those receiving MgSO4 as adjunct therapy indicated that, for nonresponders to the initial analgesic, MgSO4 did not significantly reduce pain severity at 30 or 60 minutes in comparison to secondary analgesics. Moreover, the incorporation of MgSO 4 as an adjunctive treatment did not lead to enhanced pain alleviation relative to the use of analgesics alone at the 30-minute mark. ( 31 ) In the study by Chen et al. (2020) ( 31 ) , three of the four trials assessed changes in hemodynamics and other vital signs at 30 and 60 minutes after treatment, according to the results of a meta-analysis of vital signs and hemodynamic alterations. Blood pressure, heart rate, respiration rate, oxygen saturation, and body temperature did not significantly differ between the MgSO 4 and control groups. In the Majidi et al. (2020) ( 29 ) study, adding MgSO 4 to the usual course of treatment for acute renal colic decreased the intensity of pain and the need for more morphine. However, it seems that the group that received MgSO 4 required slightly longer to reach a pain-free state. Verki et al. (2019) ( 25 ) reported that both groups' pain scores dramatically decreased after 30 minutes. Nevertheless, there were no appreciable variations in the groups' VAS scores at 15 or 30 minutes. In the present study, the ultrasound and CT findings revealed that there was no statistically significant difference in the presence of stones or hydronephrosis between the two groups. Al-Balushi et al. (2022) ( 32 ) demonstrated that in assessing patients with suspected renal colic, bedside renal PoCUS performed by emergency physicians has moderate sensitivity in detecting and grading hydronephrosis. Therefore, its use in the emergency department for screening for hydronephrosis is recommended, although additional training is necessary to increase the accuracy of the test. In the present study, there was no statistically significant difference in the improvement outcome between the two studied groups post medication ( p = .61006). The present study revealed that in each of the two studied groups, one patient (1.72%) had hypotension. Majidi et al. (2020) ( 29 ) reported that no patient in either group experienced any adverse effects, such as respiratory depression, a decreased respiratory rate, decreased arterial blood oxygen saturation, hypertension, or allergies. On the other hand, patients with known cardiac block, myocardial damage, severe renal failure, hepatitis, or Addison's disease should not take MgSO 4 . In addition, it is not advised for use during childbirth, in patients with myasthenia gravis or other neuromuscular disorders, in patients receiving cardiac glycosides, or in patients with impaired renal function. Hunter et al. (2011) ( 33 ) reported that concerns about the safety of MgSO 4 administration primarily involve the risks of haemodynamic instability and respiratory distress. However, De Oliveira et al. (2013) ( 34 ) reported that, compared with individuals who received morphine, there was no discernible hypotension in patients who underwent surgery and were given MgSO 4 for postoperative analgesia. Additionally, Ng et al. (2020) ( 35 ) reported that the occurrence of bradycardia was not significantly different from that in the control group in patients who were administered MgSO 4 for postoperative analgesia following noncardiac surgery. No additional significant adverse effects were observed in these meta-analyses relative to the control groups. The meta-analysis revealed that short-term administration of MgSO4 at restricted doses did not significantly affect patients' hemodynamics or respiratory status. ( 31 ) Chen et al. (2020), ( 31 ) performed a meta-analysis and reported that MgSO 4 did not provide enhanced therapeutic advantages relative to control therapies. It may function as a salvage drug for people unresponsive to primary analgesics. The temporary administration of MgSO 4 did not affect the hemodynamic parameters. Nonetheless, the use of MgSO 4 in conjunction with other pharmaceuticals, such as ketorolac, may improve the response time. In crowded emergency departments, where time efficiency is critical, combining MgSO 4 with faster-acting analgesics could enhance overall treatment efficacy and response speed. This approach might help in managing pain more effectively in time-sensitive situations. ( 24 ) In contrast, a 2017 study by Jokar et al. ( 12 ) examined MgSO 4 (15 mg/kg IV) as a supplementary treatment with the conventional regimen, which comprised intravenous morphine sulfate (0.1 mg/kg) and ketorolac (30 mg). The study indicated that MgSO 4 , when administered alongside normal treatment, effectively alleviated pain and diminished the requirement for morphine sulfate without impacting hemodynamic parameters. In the Sadrabad et al. (2021) ( 24 ) study, while there was no discernible difference between the magnesium and morphine groups in terms of nausea, vomiting, flushing, or dizziness, 27% of patients in the magnesium group and 22.5% of patients in the latter group experienced various problems. Furthermore, none of the patients experienced respiratory depression or hemodynamic abnormalities. Since none of the participants experienced any potentially fatal side effects, no patient's medication was interrupted. The study revealed that there are no particular negative effects that can be attributed to MgSO 4 alone; rather, it can have the same side effects as morphine sulfate. However, it is important to remember that an intravenous dose of MgSO 4 at 50 mg/kg has been shown to be safe for treating postoperative pain and to have no serious side effects. ( 26 ) They concluded that administering 50 mg/kg MgSO 4 intravenously could reduce renal colic just as well as morphine without resulting in further problems. In regard to treating renal colic, MgSO 4 in combination with other analgesics may be more beneficial than MgSO 4 . Toumia et al. (2024) ( 36 ) reported that patients with renal colic experienced better pain alleviation when intravenous MgSO 4 was added to intramuscular diclofenac. Nevertheless, MgSO₄ did not produce clinically meaningful amounts of pain alleviation. Yazdi et al. (2022) ( 37 ) demonstrated that three hours after major abdominal surgery, MgSO 4 successfully decreased pain levels without causing any unintended side effects. There was no discernible difference between the two groups within the first three hours, most likely as a result of the delayed peak effect of MgSO 4 and the ongoing effects of intraoperative analgesics. Furthermore, MgSO 4 decreased the demand for opioids during the first twenty-four hours following surgery. They concluded that, in the first 24 hours following abdominal surgery, administering magnesium as a bolus and then infusion in the intensive care unit can successfully lower pain levels and the necessary morphine dosage without causing serious side effects. CONCLUSIONS On the basis of the findings of the present study, MgSO 4 demonstrated a comparable effect and success rate in alleviating acute pain from renal colic in ED patients compared with opioids. Given the results of this study, which revealed no significant side effects with magnesium sulfate, it could be a useful adjunct in treating acute renal colic in the ED. MgSO 4 can help reduce pain severity and minimize the need for opioid medications, thereby potentially decreasing opioid-related side effects. RECOMMENDATIONS Magnesium sulfate could be a potential addition to pain control protocols for acute renal colic patients in the emergency department, given its dose-dependent nature, which requires careful dose selection to maximize efficacy while minimizing toxicity. Combining MgSO 4 with other treatments, such as NSAIDs, may provide better pain relief than MgSO 4 alone, although further research is necessary to confirm this. Despite its potential benefits, the effectiveness of MgSO4 in pain management requires further investigation, and in situations where other treatments are ineffective or unavailable, it may serve as a viable alternative with minimal side effects. LIMITATIONS The study did not consider opium addiction as a factor, meaning that the effectiveness of MgSO 4 was not evaluated in patients with addiction, so the findings may not be applicable to this population. Future studies should include opiate addicts for a more comprehensive assessment. Additionally, since the research was conducted in a single hospital, the results may not be generalizable to other healthcare settings, highlighting the need for further research in diverse environments to confirm the findings. Declarations Ethics approval and consent to participate: Human Ethics This research got ethics and research committee approval from The Scientific Research Ethics Committee at the Faculty of Medicine, Alexandria University, Egypt, September 7, 2023. Consent to participate Each patient agreed and signed an informed consent form in Arabic and English. Clinical Trial Registration The trial is registered at Pan African Clinical Trial Registration (pactr.samrc.ac.za) in 11 June 2024 under registration number: PACTR202406502996650 (pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=30560). Consent for publication: each patient agreed to publication. Availability of data and materials: Data available on request from the authors Competing Interests: The authors declare no conflicts of interest. The authors declare that they have no significant competing financial, professional, or personal interests that might have influenced the performance or presentation of the work described in this manuscript. Funding Statement: The authors received no specific funding for the conduction of this study. Authors' contributions O.S. and T.A. conceived of the presented idea. T.A. developed the theory. O.S. and T.A. verified the analytical methods. T.A. encouraged O.E. to collect the findings of this work. All authors discussed the results and contributed to the final manuscript. All authors discussed the results and contributed to the final manuscript. Acknowledgments The authors acknowledge the statistical analysis team. References Patti L, Leslie SW. Acute Renal Colic. Statpearls. Treasure Island (FL): StatPearls Publishing; 2024. Davenport K, Waine E. The Role of Non-Steroidal Anti-Inflammatory Drugs in Renal Colic. Pharmaceuticals (Basel) 2010;3(5):1304-10. Holdgate A, Pollock T. Nonsteroidal Anti-Inflammatory Drugs (Nsaids) Versus Opioids for Acute Renal Colic. Cochrane Database Syst Rev 2005;2004(2):Cd004137. Sostres C, Gargallo CJ, Lanas A. Nonsteroidal Anti-Inflammatory Drugs and Upper and Lower Gastrointestinal Mucosal Damage. Arthritis Res Ther 2013;15 Suppl 3(Suppl 3):S3. Wang Z, Zhang Y, Zhang J, Deng Q, Liang H. Recent Advances on the Mechanisms of Kidney Stone Formation (Review). Int J Mol Med 2021;48(2). Keskin ET, Bozkurt M, Özdemir H, Uğur R, Savun M, Özdemir M, et al. The Severity of Renal Colic Pain: Can It Be Predicted? Can Urol Assoc J 2023;17(9):E257-e62. Golzari SE, Soleimanpour H, Rahmani F, Zamani Mehr N, Safari S, Heshmat Y, et al. Therapeutic Approaches for Renal Colic in the Emergency Department: A Review Article. Anesth Pain Med 2014;4(1):e16222. Shokeir AA, Abdulmaaboud M, Farage Y, Mutabagani H. Resistive Index in Renal Colic: The Effect of Nonsteroidal Anti-Inflammatory Drugs. BJU Int 1999;84(3):249-51. van der Gaag WH, Roelofs PD, Enthoven WT, van Tulder MW, Koes BW. Non-Steroidal Anti-Inflammatory Drugs for Acute Low Back Pain. Cochrane Database Syst Rev 2020;4(4):Cd013581. Ganesan V, De S, Greene D, Torricelli FC, Monga M. Accuracy of Ultrasonography for Renal Stone Detection and Size Determination: Is It Good Enough for Management Decisions? BJU Int 2017;119(3):464-9. Anonymous. Renal Colic in Adults: Nsaids and Morphine Are Effective for Pain Relief. Prescrire Int 2009;18(103):217-21. Jokar A, Cyrus A, Babaei M, Taheri M, Almasi-Hashiani A, Behzadinia E, et al. The Effect of Magnesium Sulfate on Renal Colic Pain Relief; a Randomized Clinical Trial. Emerg (Tehran) 2017;5(1):e25. Holdgate A, Pollock T. Nonsteroidal Anti-Inflammatory Drugs (Nsaids) Versus Opioids for Acute Renal Colic. Cochrane Database Syst Rev 2004;10.1002/14651858.CD004137.pub2(1):Cd004137. Welk BK, Teichman JM. Pharmacological Management of Renal Colic in the Older Patient. Drugs Aging 2007;24(11):891-900. Seghatoleslami G, Sanie Jahromi MS, Farzaneh R, Rahsepar S, Malekshoar M, Vatankhah M, et al. Alternative Medical Interventions Versus Conventional Treatment of Renal Colic: An Updated Systematic Review and Network Meta-Analysis. Urol J 2022;19(6):412-9. Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR, et al. Validation of Digital Visual Analogue Scale Pain Scoring with a Traditional Paper-Based Visual Analogue Scale in Adults. JAAOS Global Research & Reviews 2018;2(3):e088. Naranjo-Hernández D, Reina-Tosina J, Roa LM. Sensor Technologies to Manage the Physiological Traits of Chronic Pain: A Review. Sensors 2020;20(2):365. Ganti S, Sohil P. Renal Colic: A Red Herring for Mucocele of the Appendiceal Stump. Case Reports in Emergency Medicine 2018;2018(1):2502183. Zhen N, De-Sheng C, Yan-Jun Y, Hua L. The Analgesic Effect of Ketorolac Addition for Renal Colic Pain: A Meta-Analysis of Randomized Controlled Studies. The American Journal of Emergency Medicine 2021;43:12-6. Kominsky HD, Rose J, Lehman A, Palettas M, Posid T, Caterino JM, et al. Trends in Acute Pain Management for Renal Colic in the Emergency Department at a Tertiary Care Academic Medical Center. Journal of endourology 2020;34(11):1195-202. Motov S, Drapkin J, Butt M, Thorson A, Likourezos A, Flom P, et al. Analgesic Administration for Patients with Renal Colic in the Emergency Department before and after Implementation of an Opioid Reduction Initiative. Western Journal of Emergency Medicine 2018;19(6):1028. AHMED EA, ZAYNAB M, EL SOOD IA. Evaluating Effectiveness of Intravenous Magnesium Sulfate as a Treatment in Acute Renal Colic Patients Attending Suez Canal University Hospital Emergency Department. The Medical Journal of Cairo University 2019;87(September):4021-5. Moharari RS, Motalebi M, Najafi A, Zamani MM, Imani F, Etezadi F, et al. Magnesium Can Decrease Postoperative Physiological Ileus and Postoperative Pain in Major Non Laparoscopic Gastrointestinal Surgeries: A Randomized Controlled Trial. Anesthesiology and Pain Medicine 2014;4(1). Sadrabad AZ, Abarghouei SA, Rad RF, Salimi Y. Intravenous Magnesium Sulfate Vs. Morphine Sulfate in Relieving Renal Colic: A Randomized Clinical Trial. The American journal of emergency medicine 2021;46:188-92. Verki MM, Porozan S, Motamed H, Fahimi MA, Aryan A. Comparison the Analgesic Effect of Magnesium Sulfate and Ketorolac in the Treatment of Renal Colic Patients: Double-Blind Clinical Trial Study. The American Journal of Emergency Medicine 2019;37(6):1033-6. Taheri A, Haryalchi K, Mansour Ghanaie M, Habibi Arejan N. Effect of Low-Dose (Single-Dose) Magnesium Sulfate on Postoperative Analgesia in Hysterectomy Patients Receiving Balanced General Anaesthesia. Anesthesiol Res Pract 2015;2015:306145. Olapour AR, Mohtadi AR, Soltanzadeh M, Ghomeishi A, Akhondzadeh R, Jafari M. The Effect of Intravenous Magnesium Sulfate Versus Intravenous Sufentanil on the Duration of Analgesia and Postoperative Pain in Patients with Tibia Fracture. Anesth Pain Med 2017;7(2):e44035. Kiran S, Gupta R, Verma D. Evaluation of a Single-Dose of Intravenous Magnesium Sulfate for Prevention of Postoperative Pain after Inguinal Surgery. Indian journal of anaesthesia 2011;55(1):31-5. Majidi A, Derakhshani F. Intravenous Magnesium Sulfate for Pain Management in Patients with Acute Renal Colic; a Randomized Clinical Trial. Arch Acad Emerg Med 2020;8(1):e5. Kocman IB, Krobot R, Premuzić J, Kocman I, Stare R, Katalinić L, et al. The Effect of Preemptive Intravenous Low-Dose Magnesium Sulfate on Early Postoperative Pain after Laparoscopic Cholecystectomy. Acta Clin Croat 2013;52(3):289-94. Chen LF, Yang CH, Lin TY, Pao PJ, Chu KC, Hsu CW, et al. Effect of Magnesium Sulfate on Renal Colic Pain: A Prisma-Compliant Meta-Analysis. Medicine (Baltimore) 2020;99(46):e23279. Al-Balushi A, Al-Shibli A, Al-Reesi A, Ullah QZ, Al-Shukaili W, Baawain S, et al. The Accuracy of Point-of-Care Ultrasound Performed by Emergency Physicians in Detecting Hydronephrosis in Patients with Renal Colic. Sultan Qaboos University Medical Journal 2022;22(3):351. Hunter LA, Gibbins KJ. Magnesium Sulfate: Past, Present, and Future. J Midwifery Womens Health 2011;56(6):566-74. De Oliveira GS, Jr., Castro-Alves LJ, Khan JH, McCarthy RJ. Perioperative Systemic Magnesium to Minimize Postoperative Pain: A Meta-Analysis of Randomized Controlled Trials. Anesthesiology 2013;119(1):178-90. Ng KT, Yap JLL, Izham IN, Teoh WY, Kwok PE, Koh WJ. The Effect of Intravenous Magnesium on Postoperative Morphine Consumption in Noncardiac Surgery: A Systematic Review and Meta-Analysis with Trial Sequential Analysis. Eur J Anaesthesiol 2020;37(3):212-23. Toumia M, Sassi S, Dhaoui R, Kouraichi C, Ali KBH, Sekma A, et al. Magnesium Sulfate Versus Lidocaine as an Adjunct for Renal Colic in the Emergency Department: A Randomized, Double-Blind Controlled Trial. Annals of Emergency Medicine 2024. Yazdi AP, Esmaeeli M, Gilani MT. Effect of Intravenous Magnesium on Postoperative Pain Control for Major Abdominal Surgery: A Randomized Double-Blinded Study. Anaesthesia and Pain Medicine 2022;17(3):280-5. Tables Tables 1 to 4 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table01DemographicData.docx Table02VAS.docx Table03USCTfindings.docx Table04Outcome.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7012120","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":496120503,"identity":"4c0bc4ef-9968-4313-9474-0edd8255601b","order_by":0,"name":"Asmaa M. 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Recent epidemiological studies highlight its increasing occurrence, with a substantial burden on healthcare systems globally. The intense pain caused by renal colic not only diminishes the quality of life for those affected but also leads to an increase in visits to the emergency department and hospital admissions.\u003csup\u003e(1)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eNSAIDs are effective analgesics and anti-inflammatories, forming the cornerstone of renal colic management. They help alleviate pain and aid in the passage of urinary stones, but their use presents certain challenges.\u003csup\u003e(2)\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003eA key challenge with NSAID therapy for renal colic is the variable response among patients. Some individuals experience insufficient pain relief despite receiving the optimal NSAID dosage. This variability highlights the need to understand the factors affecting NSAID effectiveness, such as stone size, composition, and individual differences in drug metabolism.\u003csup\u003e(3)\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003eNSAIDs are not without adverse effects, with gastrointestinal issues\u0026nbsp;such as\u0026nbsp;peptic ulcers and bleeding being common. Patients on anticoagulants, those with cardiovascular conditions, or those with renal dysfunction may be at\u0026nbsp;greater\u0026nbsp;risk. This necessitates careful clinical decision-making to balance pain relief with minimizing the risk of adverse events, particularly in more vulnerable patient groups.\u003csup\u003e(4)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe reliance on NSAIDs for renal colic management raises concerns about potential drug resistance and reduced long-term effectiveness, particularly given the chronic and recurrent nature of the condition. This highlights the need to explore alternative analgesic options, such as magnesium sulfate and opioids, for patients who are resistant or intolerant to NSAIDs. Exploring new treatment options is essential\u0026nbsp;for improving\u0026nbsp;renal colic management and patient outcomes.\u003csup\u003e(3)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eNonresponsive Ness to treatment adds complexity to managing renal colic, requiring a better understanding of the underlying factors. Variations in drug metabolism and the diverse characteristics of kidney stones, such as size, composition, and anatomical differences, can impact the effectiveness of NSAIDs. This variability highlights the complexity of renal colic and emphasizes the need for personalized treatment approaches to improve outcomes.\u003csup\u003e(5)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe diagnostic challenge of identifying\u0026nbsp;nonresponsive\u0026nbsp;cases complicates clinical decision-making in renal colic\u0026nbsp;patients. Pain assessment is largely subjective and relies on patient-reported outcomes, making it difficult to distinguish between inadequate NSAID response and the progression of the condition. A comprehensive approach, including imaging studies and ongoing clinical evaluation, is needed to address this challenge. The dilemma lies in balancing the urgency of providing effective pain relief with understanding the underlying factors contributing to\u0026nbsp;nonresponsive Ness.\u003csup\u003e(6)\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003eNonresponsive Ness\u0026nbsp;to treatment in renal colic patients extends beyond pain management, potentially leading to prolonged hospitalizations, higher healthcare costs, and a significant impact on patients\u0026apos; quality of life. This clinical challenge calls for a reevaluation of current treatment protocols and the exploration of alternative therapies to better address the needs of this patient group.\u003csup\u003e(7)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe identification of\u0026nbsp;nonresponsive\u0026nbsp;cases in the context of renal colic represents a critical phase in clinical management, requiring a nuanced and multidimensional approach.\u003csup\u003e(8)\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003eClinical assessment is the first step in identifying\u0026nbsp;nonresponsive\u0026nbsp;renal colic\u0026nbsp;patients. Pain evaluation,\u0026nbsp;which is\u0026nbsp;primarily based on subjective patient reports, helps gauge NSAID efficacy. However, the subjective nature of pain and individual variations in pain thresholds make it challenging to establish a standard for\u0026nbsp;nonresponsiveness. Clinicians must consider not only pain intensity but also the duration and frequency of pain episodes to assess treatment effectiveness\u0026nbsp;accurately.\u003csup\u003e(9)\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003eImaging studies, such as ultrasound and CT scans, are crucial in identifying\u0026nbsp;nonresponsive\u0026nbsp;renal colic cases\u0026nbsp;because they provide\u0026nbsp;detailed information on the size, location, and composition of kidney stones. When NSAIDs are ineffective, imaging helps uncover potential causes, such as larger stones or anatomical abnormalities. However, imaging results must be\u0026nbsp;interpreted\u0026nbsp;carefully, integrating them with clinical parameters for a comprehensive and collaborative diagnostic approach.\u003csup\u003e(10)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe exploration of alternative approaches in the management of renal colic becomes imperative when faced with\u0026nbsp;patients who\u0026nbsp;exhibit resistance or inadequate response to NSAIDs.\u003csup\u003e(11)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eMagnesium sulfate,\u0026nbsp;which may influence the formation and growth of calcium oxalate crystals, a key component of many kidney stones,\u0026nbsp;plays\u0026nbsp;a\u0026nbsp;role in\u0026nbsp;the\u0026nbsp;treatment of renal colic\u0026nbsp;because of\u0026nbsp;its role in neuromuscular transmission and smooth muscle relaxation by blocking NMDA receptor and\u0026nbsp;activating\u0026nbsp;adenylate cyclase\u0026nbsp;enzymes, which can alleviate spasmodic pain. Additionally,\u0026nbsp;it\u0026nbsp;inhibits pain signals in\u0026nbsp;the\u0026nbsp;dorsal nucleus of\u0026nbsp;the\u0026nbsp;hypothalamus and\u0026nbsp;prevents\u0026nbsp;them from reaching\u0026nbsp;the\u0026nbsp;central nervous system. This dual action makes magnesium sulfate a potential option for addressing both the symptoms and the underlying causes of renal colic.\u003csup\u003e(12)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eOpioids are another alternative for managing renal colic, especially when NSAIDs are ineffective. They provide pain relief by binding to specific receptors,\u0026nbsp;such\u0026nbsp;as DOP, KOP and MOP.\u003c/p\u003e\n\u003cp\u003eWhile opioids are effective in pain management, their safety concerns and potential for addiction require careful consideration. In cases where NSAIDs are contraindicated or ineffective, opioids may be a viable option for pain relief in renal colic patients.\u003csup\u003e(13)\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003eThe management of renal colic poses difficulties in striking a balance between reducing side effects and providing efficient pain relief. Opioids, while effective, carry risks such as respiratory depression, constipation, and dependence, requiring careful consideration, especially for prolonged or recurrent use.\u003csup\u003e(14)\u003c/sup\u003e This highlights the dynamic nature of renal colic management and the ongoing pursuit of personalized, patient-centered treatment strategies.\u003csup\u003e(15)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe goal of this study was to improve clinical decision-making and outcomes in renal colic management by evaluating alternative treatment options. This study aimed to systematically compare the safety and effectiveness of magnesium sulfate and opioids in patients unresponsive to NSAIDs, contributing to the evolving understanding of optimal treatment strategies and enhancing clinicians\u0026apos; therapeutic options.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research protocol received approval (7 September 2023) from the Ethics Committee of Alexandria University Faculty of Medicine (IRB No. 00012098 \u0026ndash; FWA No. 00018699) before any research-related activity commenced. This statement confirms that all research activities, including human subjects, adhered to the Declaration of Helsinki and other ethical norms established by the Research Ethics Committee of Alexandria University Faculty of Dentistry. The trial is retrospectively registered (11 June 2024) at the Pan African Clinical Trial Registry with the identification number for the registry PACTR202406502996650 .\u0026nbsp;\u003c/p\u003e"},{"header":"PATIENTS AND METHODS","content":"\u003cp\u003eThe study included 116 patients with renal colic who presented to the Emergency Department of Alexandria Main University Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSelection criteria for patients:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eAge: 18 to 65 years\u003c/li\u003e\n \u003cli\u003eRenal colic is clinically diagnosed\u003c/li\u003e\n \u003cli\u003ePatients who do not respond to NSAIDs.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eCardiac or renal disease.\u003c/li\u003e\n \u003cli\u003eRespiratory rate less than 12 breaths/minute.\u003c/li\u003e\n \u003cli\u003eSystolic blood pressure was less than 100 mmHg.\u003c/li\u003e\n \u003cli\u003eHypersensitivity to opioids or magnesium sulfate.\u003c/li\u003e\n \u003cli\u003ePregnancy and lactation.\u003c/li\u003e\n \u003cli\u003eNSAID hypersensitivity or salicylate hypersensitivity.\u003c/li\u003e\n \u003cli\u003ePatients with neuromuscular diseases, such as myasthenia gravis.\u003c/li\u003e\n \u003cli\u003eGastrointestinal bleeding and gastric ulcers.\u003c/li\u003e\n \u003cli\u003eBronchial asthma, exacerbations and Aspirin-Exacerbated Respiratory Disease.\u003c/li\u003e\n \u003cli\u003eSubstance abuse and drug addiction.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eMethods of clinical assessment:\u0026nbsp;\u003c/strong\u003eAll patients were evaluated through the following scheme:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eHistory taking and examination:\u0026nbsp;\u003c/strong\u003ePatient ID, age, sex, complaint, past medical history, past surgical history and aabdominal examination\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eVital signs,\u0026nbsp;\u003c/strong\u003eincluding\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003erespiratory rate, blood pressure, heart rate, capillary refill time and level of consciousness, were recorded according to the Glasgow Coma Scale (GCS).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eRisk scores:\u003c/strong\u003e Visual Analogue Scale\u003csup\u003e(16,17)\u003c/sup\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eLaboratory and\u0026nbsp;\u003c/strong\u003eradiological parameters, including\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eCBC results and urea, creatinine and urine analyses\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePelvic-abdomen US\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAll patients who did not respond to NSAIDs (ketorolac tomethamine) (pain assessment score \u0026gt; 6 after 30 minutes after 1 dose of 30 mg) were allocated into two groups:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe opioid group received nalbuphine (0.1\u0026ndash;0.2 mg/kg). Maximum: 20 mg): in the case of persistent pain, the dose was administered once.\u003c/li\u003e\n \u003cli\u003eThe magnesium sulfate group received magnesium sulfate (50 mg/kg body weight, maximum: 2000 mg), which was administered once.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eMeasurements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter 30, 60 and 120 minutes, both groups will be compared in terms of their outcomes according to the following:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eTime taken to relieve pain\u003c/li\u003e\n \u003cli\u003eComplications related to the drugs.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"RESULTS","content":"\u003cp\u003eFifty-eight patients were allocated to each intervention. All patients in each group completed the follow up (Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBiodata:\u0026nbsp;\u003c/strong\u003eThe two groups were age- and sex-matched, and there was no statistically significant difference in age or sex distribution between the two studied age groups (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical evaluation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no statistically significant difference in SBP between the two studied groups premedicated and post medication (\u003cem\u003ep\u003c/em\u003e=.776 and \u003cem\u003ep\u003c/em\u003e=.880, respectively). Intragroup comparisons revealed that the SBP was significantly lower after medication than before medication in the Opioids Group and the Magnesium Sulfate Group (\u003cem\u003ep\u003c/em\u003e\u0026lt;.001 and \u003cem\u003ep\u003c/em\u003e\u0026lt;.001, respectively) (Figure 2-A). There was no statistically significant difference in SBP between the two studied groups premedicated and post medication (\u003cem\u003ep\u003c/em\u003e=.847 and \u003cem\u003ep\u003c/em\u003e=.872, respectively). Intragroup comparisons revealed that the DBP was significantly lower post medication than premedication in the Opioids Group and the Magnesium Sulfate Group (\u003cem\u003ep\u003c/em\u003e\u0026lt;.001 and \u003cem\u003ep\u003c/em\u003e\u0026lt;.001, respectively) (Figure 2-B).\u0026nbsp;\u003cstrong\u003eMean arterial blood pressure\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(MABP)\u0026nbsp;\u003c/strong\u003ewas not statistically significantly different between the two groups before and after treatment (\u003cem\u003ep\u003c/em\u003e=.830 and \u003cem\u003ep\u003c/em\u003e=.980, respectively). Intragroup comparisons revealed that MABP (mmHg) was significantly lower post medication than premedication in the Opioids Group and the Magnesium Sulfate Group (\u003cem\u003ep\u003c/em\u003e\u0026lt;.001 and \u003cem\u003ep\u003c/em\u003e\u0026lt;.001, respectively) (Figure 2-C). \u003cstrong\u003eH\u003c/strong\u003e\u003cstrong\u003eeart\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003erate\u0026nbsp;\u003c/strong\u003ewas not significantly different in terms of the HR between the two studied groups before and after medication (\u003cem\u003ep\u003c/em\u003e=.800 and \u003cem\u003ep\u003c/em\u003e=.432, respectively). Intragroup comparisons revealed that the HR (beats/min) was significantly lower after medication than before medication in the Opioid Group and the Magnesium Sulfate Group (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001 and \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001, respectively). There was no statistically significant difference in the HR percentage change between the two studied groups (\u003cem\u003ep\u003c/em\u003e=.708) (Figure 2-D). \u003cstrong\u003eRespiratory rate\u003c/strong\u003e was not significantly different between the two groups premedicated and post medication (\u003cem\u003ep\u003c/em\u003e=.845 and \u003cem\u003ep\u003c/em\u003e=.086, respectively). Intragroup comparison revealed that there was a statistically significant decrease in the respiratory rate (breaths/min) post medication compared with premedication in the Opioids Group and the Magnesium Sulfate Group (\u003cem\u003ep\u003c/em\u003e\u0026lt;.001 and \u003cem\u003ep\u003c/em\u003e\u0026lt;.001, respectively) (Figure 2-E). SPO\u003csub\u003e2\u003c/sub\u003e was not significantly different in the SPO\u003csub\u003e2\u003c/sub\u003e between the two studied groups premedicated and post medicated (\u003cem\u003ep\u003c/em\u003e=.773 and \u003cem\u003ep\u003c/em\u003e=.086, respectively). Intragroup comparisons revealed that there was no statistically significant difference in the SPO\u003csub\u003e2\u0026nbsp;\u003c/sub\u003epost medication compared with the premedication values in the Opioids Group and the Magnesium Sulfate Group (\u003cem\u003ep\u003c/em\u003e=.074 and \u003cem\u003ep\u003c/em\u003e=.854, respectively) (Figure 2-F).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLaboratory analysis:\u0026nbsp;\u003c/strong\u003eThere was no statistically significant difference in the haemoglobin, WBC, platelet, urea, creatinine, pH, or PCO\u003csub\u003e3\u003c/sub\u003e or HCO\u003csub\u003e3\u003c/sub\u003e levels between the two groups (\u003cem\u003ep\u003c/em\u003e=.505, \u003cem\u003ep\u003c/em\u003e=.594, \u003cem\u003ep\u003c/em\u003e=.691, \u003cem\u003ep\u003c/em\u003e=.523, \u003cem\u003ep\u003c/em\u003e=.691, \u003cem\u003ep\u003c/em\u003e=.704, \u003cem\u003ep\u003c/em\u003e=.938, \u003cem\u003ep\u003c/em\u003e=.422, \u003cem\u003ep\u003c/em\u003e=.650, and \u003cem\u003ep\u003c/em\u003e=.883, respectively).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUrine analysis:\u0026nbsp;\u003c/strong\u003eThere was no statistically significant difference in Pus cells, RBCs or crystals in the urine between the two studied groups (\u003cem\u003ep\u003c/em\u003e=.426, \u003cem\u003ep\u003c/em\u003e=.762 and \u003cem\u003ep\u003c/em\u003e=.831, respectively).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePain assessment (Visual Analogue Scale (VAS)):\u0026nbsp;\u003c/strong\u003eThere was no statistically significant difference in the VAS score between the two studied VAS groups at 30 minutes, one hour, and two hours post medication (\u003cem\u003ep\u003c/em\u003e=.926, \u003cem\u003ep\u003c/em\u003e=.652, \u003cem\u003ep\u003c/em\u003e=.534, and \u003cem\u003ep\u003c/em\u003e=.324, respectively). The intragroup comparison revealed that the VAS score was significantly lower post medication than premedication in the Opioids Group and the Magnesium Sulfate Group (\u003cem\u003ep\u003c/em\u003e\u0026lt;.001 and \u003cem\u003ep\u003c/em\u003e\u0026lt;.001, respectively). There was no statistically significant difference in the VAS percentage change (thirty minutes postmedication vs. premedication), (one hour post medication vs. premedication), or (two hours post medication vs. premedication) between the two studied groups (\u003cem\u003ep\u003c/em\u003e=.655, \u003cem\u003ep\u003c/em\u003e=.567 and \u003cem\u003ep\u003c/em\u003e=.310, respectively).\u0026nbsp;All patients in the two\u0026nbsp;study\u0026nbsp;groups\u0026nbsp;experienced\u0026nbsp;severe pain\u0026nbsp;before receiving medication. There was no statistically significant difference in the VAS\u0026nbsp;score\u0026nbsp;between the two\u0026nbsp;study\u0026nbsp;groups\u0026nbsp;at\u0026nbsp;thirty minutes, one\u0026nbsp;hour,\u0026nbsp;and\u0026nbsp;two\u0026nbsp;hours postmedication (\u003cem\u003ep\u003c/em\u003e=.685,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e=.450 and \u003cem\u003ep\u003c/em\u003e=.594, respectively) (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUS findings:\u0026nbsp;\u003c/strong\u003eThere was no statistically significant difference in the presence of gravel stones or hydronephrosis between the two studied groups (\u003cem\u003ep\u003c/em\u003e=.8336, \u003cem\u003ep\u003c/em\u003e=.8336, and \u003cem\u003ep\u003c/em\u003e=.84148, respectively). Among the hydronephrosis patients in the Opioid Group (n=20), 85.00% had mild hydronephrosis, and 15.00% had moderate hydronephrosis. Among the hydronephrosis patients in the magnesium sulfate Group (n=19), 84.21% had mild hydronephrosis, and 15.79% had moderate hydronephrosis. There was no statistically significant difference in the severity of hydronephrosis between the two studied groups. (\u003cem\u003ep\u003c/em\u003e=.9442) (Table 3)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCT findings:\u0026nbsp;\u003c/strong\u003eIn the Opioid Group, 8.62% of the patients underwent CT, whereas in the Magnesium Sulfate Group, 5.17% of the patients underwent CT. There was no statistically significant difference in CT performance between the two studied groups (\u003cem\u003ep\u003c/em\u003e=.717). There was no statistically significant difference in the presence of stones or hydronephrosis between the two study groups (\u003cem\u003ep\u003c/em\u003e=.40654 and \u003cem\u003ep\u003c/em\u003e=.4654, respectively). Among the hydronephrosis patients in the\u003cstrong\u003e\u0026nbsp;Opioids Group (n=2),\u003c/strong\u003e 50.00% had mild hydronephrosis, and 50.00% had moderate hydronephrosis, whereas all (100.00%) of the hydronephrosis patients in the\u003cstrong\u003e\u0026nbsp;Magnesium Sulfate Group (n=2)\u0026nbsp;\u003c/strong\u003ehad mild hydronephrosis. There was no statistically significant difference in the severity of hydronephrosis between the two groups (\u003cem\u003ep\u003c/em\u003e=.25014) (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome:\u0026nbsp;\u003c/strong\u003eIn the\u003cstrong\u003e\u0026nbsp;Opioid Group,\u0026nbsp;\u003c/strong\u003e17.24% of the patients did not improve, and 82.76% improved, whereas in the \u003cstrong\u003eMagnesium Sulfate Group,\u0026nbsp;\u003c/strong\u003e17.24% did not improve, and 86.21% improved. There was no statistically significant difference (\u003cem\u003ep\u003c/em\u003e=.61006).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisposition:\u003c/strong\u003e In the\u003cstrong\u003e\u0026nbsp;Opioid Group,\u0026nbsp;\u003c/strong\u003e96.55% of the patients were disposed to the outpatient department, and 3.45% were admitted, while 100.00% of the patients in the\u003cstrong\u003e\u0026nbsp;magnesium sulfate group\u0026nbsp;\u003c/strong\u003ewere disposed to the outpatient department. There was no statistically significant difference in the improvement outcome between the two studied groups thirty minutes postmedication (\u003cem\u003ep\u003c/em\u003e=.15272).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComplications:\u0026nbsp;\u003c/strong\u003eComplications were equal in both groups (1.72%).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAcute renal colic is a sudden and severe onset of flank pain that usually begins at the costovertebral angle and radiates to the groin or testis. Nausea and vomiting are frequently symptoms of this condition, which is frequently caused by an abrupt obstruction of the urinary tract by a stone.\u003csup\u003e(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/sup\u003e Nonsteroidal anti-inflammatory drugs are the principal therapy for renal colicand function through two mechanisms: they diminish the synthesis of arachidonic acid metabolites, which stimulate pain receptors and alleviate the pain associated with renal capsule distension, and they cause the efferent arterioles to contract, thereby reducing the hydrostatic pressure across the glomerulus.\u003csup\u003e(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/sup\u003e Opioids are commonly used in treatment protocols to relieve pain; however, two significant clinical issues are associated with their use.\u003csup\u003e(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/sup\u003e The primary complication is drug dependency. The second obstacle is the variety of adverse effects that opioids can induce, such as shock, vomiting, apnea, respiratory arrest, and cardiac, blood pressure, and heart rate declines.\u003csup\u003e(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/sup\u003e Consequently, it is imperative to identify novel medications that can alleviate acute renal distress. In this context, tocolytic drugs, including magnesium sulfate, may be beneficial. Magnesium chloride is effective.\u003c/p\u003e\u003cp\u003eIn the present study, no statistically significant differences in age or sex distributions were detected between the MgSO4 and Opioid groups.\u003c/p\u003e\u003cp\u003eAhmed et al. (2019)\u003csup\u003e(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/sup\u003e assessed the efficacy of IV MgSO4 as an adjunctive therapy for the management of patients unresponsive to standard treatments (NSAIDs or opioids) due to acute renal colic and identified its ability to reduce the need for supplementary dosages of NSAIDs or opioids in the treatment of acute renal colic. There were no statistically significant changes in the age or sex distributions of the 96 patients in the trial, who were split into two groups of 48 each and ranged in age from 18\u0026ndash;60 years.\u003c/p\u003e\u003cp\u003eJokar et al. (2017)\u003csup\u003e(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/sup\u003e examined how MgSO4 affects the relief of acute renal colic pain. For the study, one hundred patients were gathered and split into two groups. 0.1 mg/kg IV MgSO4, 30 mg IV ketorolac, and 100 ml IV normal saline as a placebo were given over 15 minutes to patients in the first group as part of the conventional protocol. In addition to the usual procedure, the second group received an intravenous infusion of 15 mg/kg MgSO4 (50% solution) in 100 ml of normal saline for a period of 15 min. No instances of dizziness were reported in either group, and the study revealed no appreciable variations in the drowsiness, nausea, vomiting, or itching between the two groups. Furthermore, the control group received a considerably greater average amount of extra morphine than the MgSO4 group did (1.56 mg vs. 0.96 mg; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.043).\u003c/p\u003e\u003cp\u003eOur findings revealed that there was no statistically significant difference in the two SBP groups' vital signs (SBP, DBP, MABP, HR and SPO\u003csub\u003e2\u003c/sub\u003e) before and after medication. In alignment with the present study results, Ahmed et al. (2019)\u003csup\u003e(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/sup\u003e reported no significant differences in vital indicators, including SBP and DBP, HR, and RR, prior to the intervention or at 30 and 60 minutes postintervention.\u003c/p\u003e\u003cp\u003eMoharari-Shariat et al. (2014)\u003csup\u003e(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/sup\u003e reported no significant differences in pulse or respiratory rate following MgSO4 administration for relieving pain following major gastrointestinal nonlaparoscopic procedures. Sadrabad et al. (2021)\u003csup\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/sup\u003e assessed the effectiveness of MgSO4 versus morphine sulfate in treating renal colic, highlighting the analgesic qualities of both and the absence of the side effects of morphine when MgSO4 is used. Following the delivery of the medicine, they discovered no discernible difference in the vital signs of the MgSO4 and morphine sulfate groups. Verki et al. (2019)\u003csup\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/sup\u003e assessed the analgesic effects of MgSO4 on acute renal colic pain. The Group A patients were given standard treatment, which included 100 cc of IV normal saline as a placebo and 30 milligrams of IV ketorolac. Patients in Group B were given 50 mg/kg MgSO4 (50% solution) dissolved in regular saline. There were no discernible differences in the initial pain scores or demographic characteristics between the groups. Hemodynamic measures such as blood pressure, heart rate, respiratory rate, and oxygen saturation did not significantly change after the intervention and were similar between the two groups. In partial alignment with our findings, Jokar et al. (2017)\u003csup\u003e(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/sup\u003e reported that the two groups' SBP and DBP, respiration rates, oxygen saturation, and body temperatures at different points in time did not differ significantly. Furthermore, the mean pulse rate of the MgSO4 group was noticeably lower than that of the conventional procedure group.\u003c/p\u003e\u003cp\u003eThe present study revealed no statistically significant difference in the VAS score between the MgSO4 group and the opioid group 30 minutespostmedication or one and two hours post medication. Ahmed. Et al. (2019)\u003csup\u003e(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/sup\u003e demonstrated that after 30 minutes, the pain level of patients in the MgSO4 group, as determined by the, considerably improved. This suggests that there was a statistically significant difference in the research groups' levels of discomfort, with the MgSO4 group reporting more relief. the MgSO4 group reported significantly better pain alleviation than the control group did, indicating a statistically significant difference in pain severity between the study groups.\u003c/p\u003e\u003cp\u003eSadrabad et al. (2021)\u003csup\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/sup\u003e reported that MgSO\u003csub\u003e4\u003c/sub\u003e was evaluated against standard treatments despite not being a traditional analgesic for relieving renal colic. Magnesium sulfate significantly reduced pain with few or no adverse effects, with efficacy comparable to that of morphine. At the time of referral, the two groups' demographic traits and level of pain were comparable. The mean pain score was 4.88 for the morphine group and 5.70 for the magnesium group ten minutes after the medicine was administered; the morphine group reported less pain (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.06). However, 20 minutes later, there was no discernible difference between the mean pain scores of the morphine and magnesium groups, which were 3.65 and 3.20, respectively (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.48). The timing of the action of magnesium sulfate may be the reason for the delayed reaction compared with that of morphine sulfate. Research has shown that the effects of MgSO\u003csub\u003e4\u003c/sub\u003e on pain relief are frequently evaluated at least one hour after delivery.\u003csup\u003e(\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/sup\u003e This delayed onset might account for the slower initial response than that of more immediate-acting analgesics such as morphine sulfate. This is the first study evaluating the efficacy of MgSO4 as a single-drug treatment for renal colic.\u003c/p\u003e\u003cp\u003eJokar et al. (2017)\u003csup\u003e(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/sup\u003e reported a significant difference in pain severity on the VAS with the use of MgSO4. The study concluded that incorporating MgSO\u003csub\u003e4\u003c/sub\u003e into the standard treatment for renal colic has been shown to reduce pain severity and lower the need for additional morphine. MgSO4 can be used as an additional therapy for renal colic because it is easy to administer and has not been linked to any negative side effects. Additionally, combining MgSO\u003csub\u003e4\u003c/sub\u003e with other drugs may limit possible side effects and enable lower dosing.\u003c/p\u003e\u003cp\u003eMajidi et al. (2020)\u003csup\u003e(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/sup\u003e evaluated the effectiveness of MgSO\u003csub\u003e4\u003c/sub\u003e in treating renal colic pain in the emergency department. Ninety patients were randomly assigned to one of two equal groups and administered either morphine sulfate or MgSO\u003csub\u003e4\u003c/sub\u003e. The two groups' levels of pain were compared at different intervals, including when they were admitted to the emergency department and 20, 30, 60, 120, and 180 minutes after the medicine was administered. At each of these time points, there were no discernible changes in the groups' mean pain scores as determined by the. After 20 minutes, both groups had an identical success rate of reducing pain by at least 3 points on the VAS (91.1% each), and by 30 minutes, both groups achieved a complete reduction of 100%. At 20 minutes, a significantly greater number of patients in the morphine group were pain free (VAS score of 0) than those in the MgSO\u003csub\u003e4\u003c/sub\u003e group were (31 versus 16 patients, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.004). After thirty minutes, the percentage of pain-free patients in both groups was similar (39 versus 29, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.063).\u003c/p\u003e\u003cp\u003eJokar et al. (2017)\u003csup\u003e(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/sup\u003e compared MgSO\u003csub\u003e4\u003c/sub\u003e and ketorolac in the management of renal colic pain and reported that MgSO\u003csub\u003e4\u003c/sub\u003e effectively reduced pain and minimized the need for supplementary morphine.\u003c/p\u003e\u003cp\u003eSimilarly, Kocman et al. (2013)\u003csup\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/sup\u003e demonstrated that giving patients who underwent laparoscopic cholecystectomy a small dosage of MgSO\u003csub\u003e4\u003c/sub\u003e greatly reduced their pain.\u003c/p\u003e\u003cp\u003eChen et al. (2020)\u003csup\u003e(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/sup\u003eperformed a meta-analysis and systematic evaluation of four trials to evaluate the safety and effectiveness of MgSO\u003csub\u003e4\u003c/sub\u003e in treating renal colic in comparison with a control. By contrasting intravenous MgSO\u003csub\u003e4\u003c/sub\u003e with a control, every RCT that was part of the systematic review and meta-analysis evaluated the degree of pain experienced by individuals with renal colic. The meta-analysis revealed that MgSO\u003csub\u003e4\u003c/sub\u003e did not significantly reduce discomfort at 15, 30, or 60 minutes.\u003c/p\u003e\u003cp\u003eThe examination of restricted data from studies involving patients unresponsive to initial analgesic doses or those receiving MgSO4 as adjunct therapy indicated that, for nonresponders to the initial analgesic, MgSO4 did not significantly reduce pain severity at 30 or 60 minutes in comparison to secondary analgesics. Moreover, the incorporation of MgSO\u003csub\u003e4\u003c/sub\u003e as an adjunctive treatment did not lead to enhanced pain alleviation relative to the use of analgesics alone at the 30-minute mark.\u003csup\u003e(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/sup\u003e In the study by Chen et al. (2020)\u003csup\u003e(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/sup\u003e, three of the four trials assessed changes in hemodynamics and other vital signs at 30 and 60 minutes after treatment, according to the results of a meta-analysis of vital signs and hemodynamic alterations. Blood pressure, heart rate, respiration rate, oxygen saturation, and body temperature did not significantly differ between the MgSO\u003csub\u003e4\u003c/sub\u003e and control groups. In the Majidi et al. (2020)\u003csup\u003e(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/sup\u003e study, adding MgSO\u003csub\u003e4\u003c/sub\u003e to the usual course of treatment for acute renal colic decreased the intensity of pain and the need for more morphine. However, it seems that the group that received MgSO\u003csub\u003e4\u003c/sub\u003e required slightly longer to reach a pain-free state. Verki et al. (2019)\u003csup\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/sup\u003e reported that both groups' pain scores dramatically decreased after 30 minutes. Nevertheless, there were no appreciable variations in the groups' VAS scores at 15 or 30 minutes.\u003c/p\u003e\u003cp\u003eIn the present study, the ultrasound and CT findings revealed that there was no statistically significant difference in the presence of stones or hydronephrosis between the two groups.\u003c/p\u003e\u003cp\u003eAl-Balushi et al. (2022)\u003csup\u003e(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/sup\u003e demonstrated that in assessing patients with suspected renal colic, bedside renal PoCUS performed by emergency physicians has moderate sensitivity in detecting and grading hydronephrosis. Therefore, its use in the emergency department for screening for hydronephrosis is recommended, although additional training is necessary to increase the accuracy of the test. In the present study, there was no statistically significant difference in the improvement outcome between the two studied groups post medication (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.61006). The present study revealed that in each of the two studied groups, one patient (1.72%) had hypotension.\u003c/p\u003e\u003cp\u003eMajidi et al. (2020)\u003csup\u003e(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/sup\u003e reported that no patient in either group experienced any adverse effects, such as respiratory depression, a decreased respiratory rate, decreased arterial blood oxygen saturation, hypertension, or allergies. On the other hand, patients with known cardiac block, myocardial damage, severe renal failure, hepatitis, or Addison's disease should not take MgSO\u003csub\u003e4\u003c/sub\u003e. In addition, it is not advised for use during childbirth, in patients with myasthenia gravis or other neuromuscular disorders, in patients receiving cardiac glycosides, or in patients with impaired renal function. Hunter et al. (2011)\u003csup\u003e(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/sup\u003e reported that concerns about the safety of MgSO\u003csub\u003e4\u003c/sub\u003e administration primarily involve the risks of haemodynamic instability and respiratory distress.\u003c/p\u003e\u003cp\u003eHowever, De Oliveira et al. (2013)\u003csup\u003e(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e)\u003c/sup\u003e reported that, compared with individuals who received morphine, there was no discernible hypotension in patients who underwent surgery and were given MgSO\u003csub\u003e4\u003c/sub\u003e for postoperative analgesia.\u003c/p\u003e\u003cp\u003eAdditionally, Ng et al. (2020)\u003csup\u003e(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/sup\u003e reported that the occurrence of bradycardia was not significantly different from that in the control group in patients who were administered MgSO\u003csub\u003e4\u003c/sub\u003e for postoperative analgesia following noncardiac surgery. No additional significant adverse effects were observed in these meta-analyses relative to the control groups. The meta-analysis revealed that short-term administration of MgSO4 at restricted doses did not significantly affect patients' hemodynamics or respiratory status.\u003csup\u003e(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eChen et al. (2020), \u003csup\u003e(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/sup\u003e performed a meta-analysis and reported that MgSO\u003csub\u003e4\u003c/sub\u003e did not provide enhanced therapeutic advantages relative to control therapies. It may function as a salvage drug for people unresponsive to primary analgesics. The temporary administration of MgSO\u003csub\u003e4\u003c/sub\u003e did not affect the hemodynamic parameters.\u003c/p\u003e\u003cp\u003eNonetheless, the use of MgSO\u003csub\u003e4\u003c/sub\u003e in conjunction with other pharmaceuticals, such as ketorolac, may improve the response time. In crowded emergency departments, where time efficiency is critical, combining MgSO\u003csub\u003e4\u003c/sub\u003e with faster-acting analgesics could enhance overall treatment efficacy and response speed. This approach might help in managing pain more effectively in time-sensitive situations.\u003csup\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn contrast, a 2017 study by Jokar et al.\u003csup\u003e(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/sup\u003e examined MgSO\u003csub\u003e4\u003c/sub\u003e (15 mg/kg IV) as a supplementary treatment with the conventional regimen, which comprised intravenous morphine sulfate (0.1 mg/kg) and ketorolac (30 mg). The study indicated that MgSO\u003csub\u003e4\u003c/sub\u003e, when administered alongside normal treatment, effectively alleviated pain and diminished the requirement for morphine sulfate without impacting hemodynamic parameters.\u003c/p\u003e\u003cp\u003eIn the Sadrabad et al. (2021)\u003csup\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/sup\u003e study, while there was no discernible difference between the magnesium and morphine groups in terms of nausea, vomiting, flushing, or dizziness, 27% of patients in the magnesium group and 22.5% of patients in the latter group experienced various problems. Furthermore, none of the patients experienced respiratory depression or hemodynamic abnormalities. Since none of the participants experienced any potentially fatal side effects, no patient's medication was interrupted. The study revealed that there are no particular negative effects that can be attributed to MgSO\u003csub\u003e4\u003c/sub\u003e alone; rather, it can have the same side effects as morphine sulfate. However, it is important to remember that an intravenous dose of MgSO\u003csub\u003e4\u003c/sub\u003e at 50 mg/kg has been shown to be safe for treating postoperative pain and to have no serious side effects.\u003csup\u003e(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/sup\u003e They concluded that administering 50 mg/kg MgSO\u003csub\u003e4\u003c/sub\u003e intravenously could reduce renal colic just as well as morphine without resulting in further problems. In regard to treating renal colic, MgSO\u003csub\u003e4\u003c/sub\u003e in combination with other analgesics may be more beneficial than MgSO\u003csub\u003e4\u003c/sub\u003e.\u003c/p\u003e\u003cp\u003eToumia et al. (2024)\u003csup\u003e(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e)\u003c/sup\u003e reported that patients with renal colic experienced better pain alleviation when intravenous MgSO\u003csub\u003e4\u003c/sub\u003e was added to intramuscular diclofenac. Nevertheless, MgSO₄ did not produce clinically meaningful amounts of pain alleviation. Yazdi et al. (2022)\u003csup\u003e(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e)\u003c/sup\u003e demonstrated that three hours after major abdominal surgery, MgSO\u003csub\u003e4\u003c/sub\u003e successfully decreased pain levels without causing any unintended side effects. There was no discernible difference between the two groups within the first three hours, most likely as a result of the delayed peak effect of MgSO\u003csub\u003e4\u003c/sub\u003e and the ongoing effects of intraoperative analgesics. Furthermore, MgSO\u003csub\u003e4\u003c/sub\u003e decreased the demand for opioids during the first twenty-four hours following surgery. They concluded that, in the first 24 hours following abdominal surgery, administering magnesium as a bolus and then infusion in the intensive care unit can successfully lower pain levels and the necessary morphine dosage without causing serious side effects.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eOn the basis of the findings of the present study, MgSO\u003csub\u003e4\u003c/sub\u003e demonstrated a comparable effect and success rate in alleviating acute pain from renal colic in ED patients compared with opioids. Given the results of this study, which revealed no significant side effects with magnesium sulfate, it could be a useful adjunct in treating acute renal colic in the ED. MgSO\u003csub\u003e4\u003c/sub\u003e can help reduce pain severity and minimize the need for opioid medications, thereby potentially decreasing opioid-related side effects.\u003c/p\u003e"},{"header":"RECOMMENDATIONS","content":"\u003cp\u003eMagnesium sulfate could be a potential addition to pain control protocols for acute renal colic patients in the emergency department, given its dose-dependent nature, which requires careful dose selection to maximize efficacy while minimizing toxicity. Combining MgSO\u003csub\u003e4\u003c/sub\u003e with other treatments, such as NSAIDs, may provide better pain relief than MgSO\u003csub\u003e4\u003c/sub\u003e alone, although further research is necessary to confirm this. Despite its potential benefits, the effectiveness of MgSO4 in pain management requires further investigation, and in situations where other treatments are ineffective or unavailable, it may serve as a viable alternative with minimal side effects.\u003c/p\u003e"},{"header":"LIMITATIONS","content":"\u003cp\u003eThe study did not consider opium addiction as a factor, meaning that the effectiveness of MgSO\u003csub\u003e4\u003c/sub\u003e was not evaluated in patients with addiction, so the findings may not be applicable to this population. Future studies should include opiate addicts for a more comprehensive assessment. Additionally, since the research was conducted in a single hospital, the results may not be generalizable to other healthcare settings, highlighting the need for further research in diverse environments to confirm the findings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eHuman Ethics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research got ethics and research committee approval from The Scientific Research Ethics Committee at the Faculty of Medicine, Alexandria University, Egypt, September 7, 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEach patient agreed and signed an informed consent form in Arabic and English.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe trial is registered at Pan African Clinical Trial Registration (pactr.samrc.ac.za) in 11 June 2024 under registration number: PACTR202406502996650 (pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=30560).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eeach patient agreed to publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eData available on request from the authors\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u0026nbsp;\u003c/strong\u003eThe authors declare no conflicts of interest. The authors declare that they have no significant competing financial, professional, or personal interests that might have influenced the performance or presentation of the work described in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement:\u0026nbsp;\u003c/strong\u003eThe authors received no specific funding for the conduction of this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eO.S. and T.A. conceived of the presented idea. T.A. developed the theory.\u003c/p\u003e\n\u003cp\u003eO.S. and T.A. verified the analytical methods. T.A. encouraged O.E. to collect the findings of this work. All authors discussed the results and contributed to the final manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors discussed the results and contributed to the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003eThe authors acknowledge the statistical analysis team.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePatti L, Leslie SW. Acute Renal Colic. Statpearls. Treasure Island (FL): StatPearls Publishing; 2024.\u003c/li\u003e\n\u003cli\u003eDavenport K, Waine E. The Role of Non-Steroidal Anti-Inflammatory Drugs in Renal Colic. Pharmaceuticals (Basel) 2010;3(5):1304-10.\u003c/li\u003e\n\u003cli\u003eHoldgate A, Pollock T. Nonsteroidal Anti-Inflammatory Drugs (Nsaids) Versus Opioids for Acute Renal Colic. Cochrane Database Syst Rev 2005;2004(2):Cd004137.\u003c/li\u003e\n\u003cli\u003eSostres C, Gargallo CJ, Lanas A. 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Comparison the Analgesic Effect of Magnesium Sulfate and Ketorolac in the Treatment of Renal Colic Patients: Double-Blind Clinical Trial Study. The American Journal of Emergency Medicine 2019;37(6):1033-6.\u003c/li\u003e\n\u003cli\u003eTaheri A, Haryalchi K, Mansour Ghanaie M, Habibi Arejan N. Effect of Low-Dose (Single-Dose) Magnesium Sulfate on Postoperative Analgesia in Hysterectomy Patients Receiving Balanced General Anaesthesia. Anesthesiol Res Pract 2015;2015:306145.\u003c/li\u003e\n\u003cli\u003eOlapour AR, Mohtadi AR, Soltanzadeh M, Ghomeishi A, Akhondzadeh R, Jafari M. The Effect of Intravenous Magnesium Sulfate Versus Intravenous Sufentanil on the Duration of Analgesia and Postoperative Pain in Patients with Tibia Fracture. Anesth Pain Med 2017;7(2):e44035.\u003c/li\u003e\n\u003cli\u003eKiran S, Gupta R, Verma D. Evaluation of a Single-Dose of Intravenous Magnesium Sulfate for Prevention of Postoperative Pain after Inguinal Surgery. Indian journal of anaesthesia 2011;55(1):31-5.\u003c/li\u003e\n\u003cli\u003eMajidi A, Derakhshani F. Intravenous Magnesium Sulfate for Pain Management in Patients with Acute Renal Colic; a Randomized Clinical Trial. Arch Acad Emerg Med 2020;8(1):e5.\u003c/li\u003e\n\u003cli\u003eKocman IB, Krobot R, Premuzić J, Kocman I, Stare R, Katalinić L, et al. The Effect of Preemptive Intravenous Low-Dose Magnesium Sulfate on Early Postoperative Pain after Laparoscopic Cholecystectomy. Acta Clin Croat 2013;52(3):289-94.\u003c/li\u003e\n\u003cli\u003eChen LF, Yang CH, Lin TY, Pao PJ, Chu KC, Hsu CW, et al. Effect of Magnesium Sulfate on Renal Colic Pain: A Prisma-Compliant Meta-Analysis. Medicine (Baltimore) 2020;99(46):e23279.\u003c/li\u003e\n\u003cli\u003eAl-Balushi A, Al-Shibli A, Al-Reesi A, Ullah QZ, Al-Shukaili W, Baawain S, et al. The Accuracy of Point-of-Care Ultrasound Performed by Emergency Physicians in Detecting Hydronephrosis in Patients with Renal Colic. Sultan Qaboos University Medical Journal 2022;22(3):351.\u003c/li\u003e\n\u003cli\u003eHunter LA, Gibbins KJ. Magnesium Sulfate: Past, Present, and Future. J Midwifery Womens Health 2011;56(6):566-74.\u003c/li\u003e\n\u003cli\u003eDe Oliveira GS, Jr., Castro-Alves LJ, Khan JH, McCarthy RJ. Perioperative Systemic Magnesium to Minimize Postoperative Pain: A Meta-Analysis of Randomized Controlled Trials. Anesthesiology 2013;119(1):178-90.\u003c/li\u003e\n\u003cli\u003eNg KT, Yap JLL, Izham IN, Teoh WY, Kwok PE, Koh WJ. The Effect of Intravenous Magnesium on Postoperative Morphine Consumption in Noncardiac Surgery: A Systematic Review and Meta-Analysis with Trial Sequential Analysis. Eur J Anaesthesiol 2020;37(3):212-23.\u003c/li\u003e\n\u003cli\u003eToumia M, Sassi S, Dhaoui R, Kouraichi C, Ali KBH, Sekma A, et al. Magnesium Sulfate Versus Lidocaine as an Adjunct for Renal Colic in the Emergency Department: A Randomized, Double-Blind Controlled Trial. Annals of Emergency Medicine 2024.\u003c/li\u003e\n\u003cli\u003eYazdi AP, Esmaeeli M, Gilani MT. Effect of Intravenous Magnesium on Postoperative Pain Control for Major Abdominal Surgery: A Randomized Double-Blinded Study. Anaesthesia and Pain Medicine 2022;17(3):280-5.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 4 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Magnesium Sulfate, Renal Colic, Unresponsive to Nonsteroidal Anti-Inflammatory Drugs","lastPublishedDoi":"10.21203/rs.3.rs-7012120/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7012120/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eRenal colic is a distressing and recurrent condition frequently encountered in emergency departments. Opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) are the primary treatment options. Opioids are associated with concerns of drug dependency and side effects. Magnesium sulfate (MgSO4) has beenreported to have analgesic effects on reducing pain following major lumbar surgery and laparoscopic cholecystectomy. Moreover, studies have demonstrated the effectiveness of MgSO4 as an adjunct therapy in the management of renal colic patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives: \u003c/strong\u003eThis study aims to evaluate IV MgSO4 as an alternative to opioids for renal colic patients unresponsive to NSAIDs, assessing pain relief time, treatment failure, admission rates, and complications such as anaphylaxis and dependency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and methods:\u003c/strong\u003e This study included 116 renal colic patients at Alexandria Main University Hospital who did not respond to NSAIDs, defined as those with a pain score \u0026gt;6 after 30 minutes of 30 mg. The patients were divided into two groups: the Opioid Group, which received nalbuphine (0.1–0.2 mg/kg, up to 20 mg), and the MgSO4 Group, which received magnesium sulfate (50 mg/kg, up to 2000 mg). Treatment outcomes were assessed and compared at 30, 60, and 120 minutes to evaluate the effectiveness of both approaches.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e This study revealed no statistically significant differences between the two groups in terms of pain scores, vital signs, hematological and urinefindings, or ultrasound and CT findings before and after treatment in terms of overall improvement in outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e MgSO4 is as effective as opioids in relieving acute renal colic pain in the ED, with fewer side effects. It can reduce pain while minimizing opioid use and related risks.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration: \u003c/strong\u003eThe trial is retrospectively registered at the Pan African Clinical Trial Registry with the identification number for the registry PACTR202406502996650.\u003c/p\u003e","manuscriptTitle":"Comparison of Magnesium Sulfate And Opioids in The Management of Renal Colic Unresponsive to Non-Steroidal Anti-Inflammatory Drugs","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-07 04:12:11","doi":"10.21203/rs.3.rs-7012120/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9e0c1b3f-d9d9-4fa4-acaf-e1619c8f510e","owner":[],"postedDate":"August 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-25T08:24:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-07 04:12:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7012120","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7012120","identity":"rs-7012120","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}