Nephrology for the Family Physician - O.I. Bakaliuk 2003

Emergency Uro-Nephrology
Renal Colic

Emergency management of Renal Colic begins with thermal Procedures (heating pad on the lumbar region, warm bath), reflex therapies targeting the Zakharyin-HEAD zones in the renal area—such as ethyl chloride Skin spray of the lumbar region, application of irritating ointments and solutions to the lower back (Apizartron, Efкаmon, Golden Star balm, Finalgon, Menovazin), mustard plasters, pepper patches, medical leeches, Solux or infrared lamps, inductothermy, UHF therapy, and microwave therapy. Astvatsaturov's intradermal novocaine block of the lumbar region, as well as blocks of the Spermatic Cord or round ligament of the Uterus, are also recommended.

If these measures fail, spasmoanalgesics are used (Baralgin 5.0 intravenously or intramuscularly, Maxigan 5 ml intravenously, or tablets of Baralgin, Trigan, Maxigan, Tempalgin, Spasmalgon), analgesics (narcotic: Promedol 2% - 1 ml; non-narcotic: Analgin 50% - 2 ml intravenously or intramuscularly), neuroleptics (Droperidol 0.25% - 2 ml, Aminazine 2.5% - 1 ml intramuscularly), myotropic antispasmodics (No-shpa 2% - 2 ml, Galidor 2.5% - 2 ml, Papaverine 2% - 2 ml intramuscularly), M-cholinolytics (Atropine 0.1% - 1 ml, Metacin 0.1% - 1 ml, Platyphylline 0.2% - 1 ml intramuscularly), and antihistamines (Diphenhydramine 1% - 1 ml, Pipolfen 2% - 1 ml, Suprastin 2% - 1 ml, Tavegil 0.1% - 1 ml intramuscularly). All of the above agents are administered as lytic cocktails (1 ml of medication from each group).

To block the Excessive production of PGs released in the area of Muscle spasm and the renal medulla, NSAIDs are prescribed (Voltaren, Profenid, Diclofenac sodium, Mesulid, Movalis).

Technique of ethyl chloride block. Paravertebral skin irrigation of the lumbar region is performed from a distance of 10–15 cm, starting from the scapular angle down to the upper iliac crest. The tip of the side protrusion of the ethyl chloride ampoule should be carefully snapped off. A total of 15–25 ml of ethyl chloride is used for the block. Irrigation is continued until a "frost" layer forms over a 2–2.5 cm² skin area. At this point, the patient experiences a sensation resembling a needle prick. Afterward, the chilled site must be vigorously rubbed until hyperemia develops. Analgesia sets in within 1–2 minutes and lasts for 20–30 minutes, occasionally relieving the pain completely.

Technique of Astvatsaturov's intradermal novocaine block. With the patient positioned on their healthy side or abdomen, the skin is disinfected with alcohol. In the area of maximal tenderness in the lumbar region—extending from the costovertebral angle downward along the spine—1 ml of a 0.5% novocaine solution is injected intradermally to form "lemon peel" wheals at 4–6 sites, spaced 1.5–2 cm apart. This Procedure can also be performed using needleless pneumatic injectors BI-2 and BI-3.

Technique of Lorin-Epstein's novocaine block. In male patients, the spermatic cord is grasped between the thumb and index finger of the left hand. A volume of 60–80 ml of a 0.25–0.5% novocaine solution is injected into its thickness in the area of the superficial inguinal ring. In female patients, the novocaine solution is injected into the region of the peripheral section of the round ligament of the uterus.

The Use of a paranephral block during a renal colic attack remains controversial. A well-reasoned argument suggests that this manipulation should be used extremely sparingly (Yu.A. Pytel et al., 1985), which is explained by several circumstances.

Firstly, a paranephral block can be complicated by Kidney injury leading to a massive hematoma (resulting from local venous Hypertension); secondly, injecting 100–120 ml of novocaine into the paranephral tissue further exacerbates its interstitial edema, while accidental damage to the renal capsule can trigger the rupture of a tense kidney (A.V. Yepishin, 1998). Moreover, infiltrating the renal plexus zone directly with novocaine using this technique is technically quite challenging.

Failure to achieve an effect with the aforementioned physiotherapeutic and pharmacological measures necessitates emergency interventions, specifically endovesical ureteral blockage, meatotomy for a stone entrapped at the ureteral orifice, or ureteral catheterization. If passing a urinary catheter beyond the obstruction is impossible, pyelolithotomy or ureterolithotomy is indicated. All these procedures are performed in a specialized urology department.