Tedaviye Dirençli Renal Kolikte Tamamlayıcı Kurtarma Tedavisi Olarak Dermal Blokaj: Retrospektif Karşılaştırmalı Kohort Çalışması

Öz

Amaç: Renal kolik, sıklıkla hızlı analjezi gerektiren yaygın ve ağrılı bir ürolojik acildir. İlk basamak tedaviye rağmen ağrısı devam eden hastalarda etkili kurtarma tedavilerine ihtiyaç duyulmaktadır. Bu çalışmanın amacı, tedaviye dirençli renal kolik hastalarında dermal blokajın konvansiyonel ek analjezik tedaviye kıyasla etkinliğini değerlendirmektir.
Materyal ve metod: Bu retrospektif karşılaştırmalı kohort çalışmaya, Eylül 2013-Mayıs 2018 tarihleri arasında başlangıç tedavisine rağmen şiddetli ağrısı devam eden 165 renal kolik hastası dahil edildi. Hastaların 72’sine dermal blokaj, 93’üne ise konvansiyonel ek analjezik tedavi uygulandı. Ağrı şiddeti başlangıçta ve tedavi sonrası 1., 15., 30. ve 60. dakikalarda Görsel Analog Skala (VAS) kullanılarak değerlendirildi. Birincil sonlanım noktası 30. dakikadaki VAS değişimi (ΔVAS30) olarak önceden tanımlandı. İkincil sonlanımlar klinik başarı (VAS ≤3), ≥%50 ağrı azalması, ağrı nüksü, ağrısız süre, tekrar müdahale gereksinimi ve acil üriner diversiyon ihtiyacını içeriyordu.
Bulgular: Gruplar demografik, klinik ve taş ilişkili özellikler açısından benzerdi. Birincil sonlanım noktası olan ΔVAS30, dermal blokaj grubunda konvansiyonel tedavi grubuna kıyasla anlamlı olarak daha yüksekti (7,78±1,68 ve 6,87±1,97; ortalama fark: 0,91, %95 güven aralığı (GA): 0,33-1,49; p=0,003). Klinik başarı oranı dermal blokaj grubunda daha yüksekti (%77,8 ve %52,7; olasılık oranı (OO)=3,14, %95 GA: 1,61-6,11; p=0,001). Çok değişkenli doğrusal regresyon analizinde dermal blokaj, ΔVAS30’da daha büyük iyileşme ile bağımsız olarak ilişkili bulundu (B=-0,870, p=0,007). Benzer şekilde, çok değişkenli lojistik regresyonda dermal blokaj, 30. dakikada klinik başarı ile bağımsız olarak ilişkiliydi (düzeltilmiş OO=2,96, %95 GA: 1,35-8,85; p=0,009). Ağrı nüksü, ağrısız süre, tekrar müdahale ve acil üriner diversiyon açısından gruplar arasında anlamlı fark saptanmadı.
Sonuç: Dermal blokaj, tedaviye dirençli renal kolikli hastalarda konvansiyonel ek analjezik tedaviye kıyasla daha iyi erken dönem ağrı kontrolü ile ilişkili bulunmuştur. 

Anahtar Kelimeler

• Renal kolik
• İntradermal steril su enjeksiyonu
• Dermal blokaj
• Tamamlayıcı tıp
• Akut ağrı yönetimi

Etik Beyan

The study was approved by the Non-Interventional Clinical Research Ethics Committee of Adıyaman University (approval no: 2018/5-5, date: May 24, 2018).

Dermal Blockade As A Complementary Rescue Treatment For Refractory Renal Colic: A Retrospective Comparative Cohort Study

Öz

Background: Renal colic is a frequent and painful urological emergency requiring rapid analgesia. Although non-steroidal anti-inflammatory drugs and opioids are widely used, some patients remain symptomatic or have contraindications. Dermal blockade via intradermal sterile water injection has been proposed as a simple complementary treatment, but its role as a rescue strategy in refractory cases remains unclear. 
Materials and Methods: In this retrospective comparative cohort study, 165 patients with persistent renal colic despite initial therapy were included. Patients received either dermal blockade (n=72) or conventional additional analgesia (n=93). Pain was assessed using the Visual Analog Scale (VAS) at baseline and at 1, 15, 30, and 60 minutes. The primary outcome was change in VAS score at 30 minutes (ΔVAS30). Secondary outcomes included clinical success (VAS ≤3), ≥50% pain reduction, pain recurrence, pain-free duration, repeat intervention, and urgent urinary diversion. 
Results: Baseline demographic, clinical, and stone-related characteristics, including stone size, stone location, and hydronephrosis grade, were comparable between groups. The primary endpoint, ΔVAS30, was significantly greater in the dermal blockade group than in the conventional additional analgesia group (7.78±1.68 vs. 6.87±1.97; mean difference [MD] 0.91, 95% confidence interval (CI) 0.33-1.49; p=0.003). Patients receiving dermal blockade also demonstrated lower VAS scores at all post-treatment time points and higher rates of clinical success at 30 minutes (77.8% vs. 52.7%; odds ratio (OR) 3.14, 95% CI 1.61-6.11; p=0.001). In longitudinal mixed-effects analysis, pain scores declined more rapidly in the dermal blockade group (group × time interaction: β=-0.31, 95% CI -0.49 to -0.13; p=0.001). After adjustment for age, sex, body mass index, renal dysfunction, stone size, stone location, and hydronephrosis grade, dermal blockade remained independently associated with clinical success at 30 minutes (adjusted OR 3.46, corresponding to conventional treatment OR 0.289, 95% CI 1.35-8.85; p=0.009). Secondary outcomes, including pain recurrence, pain-free duration, repeat intervention, and urgent urinary diversion, were similar between groups. 
Conclusions: Dermal blockade was associated with improved early pain outcomes and greater short-term pain reduction in patients with refractory renal colic. 

Anahtar Kelimeler

• Renal colic
• Intradermal sterile water injection
• Dermal blockade
• Complementary medicine
• Acute pain management

Etik Beyan

The study was approved by the Non-Interventional Clinical Research Ethics Committee of Adıyaman University (approval no: 2018/5-5, date: May 24, 2018).

Kaynakça

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