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

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.