Investigating the Analgesic Effect of Sublingual Glycerol Trinitrate (GTN) Spray as an Alternative Treatment in Renal Colic Pain: A Triple-Blinded Randomized Controlled Trial
-
Paria Sadat Ramezany
,
Mohammed Ali Shadram
,
Ahmad Reza Dehpour
,
Razieh Mohammad Jafari
,
Morteza Saeedi
,
Mehrad Aghili
,
Javad Seyedhosseini
Abstract
Renal colic, a severe pain caused by renal and urethral calculi, causes millions of patients to visit the emergency department (ED) worldwide each year. Based on international guidelines, NSAIDs are the first-line analgesics of choice for renal colic management. The second most preferred analgesic is opioids. NSAIDs and opioids have several complications and contraindications that limit their administration and necessitate the search for alternative treatments for renal colic pain. The present study aimed to assess the effect of sublingual Glycerol Trinitrate (GTN) spray, a smooth muscle-relaxing agent, on renal colic pain as an alternative treatment. In this triple-blinded randomized controlled trial, 94 patients with renal colic who visited the emergency department (ED) were included. The drug group included 48 patients who were administered sublingual GTN spray, and the placebo group consisted of 46 patients. After diagnosis, the patients' pain was assessed based on the Numeric Rating Scale (NRS), a 30-milligram dose of ketorolac was administered to all patients, and sublingual GTN/placebo spray was administrated. The pain was also recorded 5 min after spray administration. Again, 30 min after spray administration, the NRS was reassessed. 94 patients enrolled in this study, the mean age of the participants was 39.22±11.72, and 82 (87.23%) of them were male. Five minutes after GTN/placebo administration, The NRS in both groups decreased significantly compared with the NRS upon arrival (P<0.01). Furthermore, in both groups, the NRS measured at 30 minutes also decreased significantly from the NRS measured at 5 minutes (P<0.01). Nevertheless, the reduction in the NRS score between the drug and placebo groups was not significantly different (P=0.365). Our results showed no significant pain reduction with sublingual GTN spray in comparison with placebo; thus, sublingual GTN spray might not have considerable analgesic effects in patients with renal colic referred to the ED.
1. Marx J, Hockberger R, Walls R. Rosen's Emergency Medicine - Concepts and Clinical Practice E-Book: 2-Volume Set: Elsevier Health Sciences; 2013.
2. Moussa M, Papatsoris AG, Chakra MA. Intradermal sterile water injection versus diclofenac sodium in acute renal colic pain: A randomized controlled trial. Am J Emerg Med 2021;44:395-400.
3. Razi A, Farrokhi E, Lotfabadi P, Hosseini SS, Saadati H, Haghighi R, et al. Dexamethasone and ketorolac compare with ketorolac alone in acute renal colic: A randomized clinical trial. Am J Emerg Med 2022;58:245-50.
4. Tu JF, Cao Y, Wang LQ, Shi GX, Jia LC, Liu BL, et al. Effect of Adjunctive Acupuncture on Pain Relief Among Emergency Department Patients With Acute Renal Colic Due to Urolithiasis: A Randomized Clinical Trial. JAMA Netw Open 2022;5:e2225735.
5. Zolfaghari Sadrabad A, Azimi Abarghouei S, Farahmand Rad R, Salimi Y. Intravenous magnesium sulfate vs. morphine sulfate in relieving renal colic: A randomized clinical trial. Am J Emerg Med 2021;46:188-92.
6. Jang Y, Kim M, Hwang SW. Molecular mechanisms underlying the actions of arachidonic acid-derived prostaglandins on peripheral nociception. J Neuroinflammation 2020;17:30.
7. Ghani KR, Roghmann F, Sammon JD, Trudeau V, Sukumar S, Rahbar H, et al. Emergency department visits in the United States for upper urinary tract stones: trends in hospitalization and charges. J Urol 2014;191:90-6.
8. Pickard R, Starr K, MacLennan G, Lam T, Thomas R, Burr J, et al. Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Lancet 2015;386:341-9.
9. 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:e16222.
10. Holdgate A, Pollock T. Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic. BMJ 2004;328:1401.
11. Jalili M, Shirani F, Entezari P, Hedayatshodeh M, Baigi V, Mirfazaelian H. Desmopressin/indomethacin combination efficacy and safety in renal colic pain management: A randomized placebo controlled trial. Am J Emerg Med 2019;37:1009-12.
12. Maleki Verki M, Porozan S, Motamed H, Fahimi MA, Aryan A. Comparison the analgesic effect of magnesium sulphate and Ketorolac in the treatment of renal colic patients: Double-blind clinical trial study. Am J Emerg Med 2019;37:1033-6.
13. Mozafari J, Maleki Verki M, Motamed H, Sabouhi A, Tirandaz F. Comparing intranasal ketamine with intravenous fentanyl in reducing pain in patients with renal colic: A double-blind randomized clinical trial. Am J Emerg Med 2020;38:549-53.
14. Soleimanpour H, Hassanzadeh K, Vaezi H, Golzari SE, Esfanjani RM, Soleimanpour M. Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department. BMC Urol 2012;12:13.
15. Hamidi N, Ozturk E, Yikilmaz TN, Atmaca AF, Basar H. The effect of corticosteroid on postoperative early pain, renal colic and total analgesic consumption after uncomplicated and unstented ureteroscopy: a matched-pair analysis. World J Urol 2018;36:979-84.
16. Tsiotras A, Smith RD, Pearce I, O’Flynn K, Wiseman O. British Association of Urological Surgeons standards for management of acute ureteric colic. J Clin Urol 2018;11:58-61.
17. Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis. Eur Urol 2016;69:468-74.
18. Miller NL, Lingeman JE. Management of kidney stones. BMJ 2007;334:468-72.
19. Lichtenberger LM, Wang ZM, Romero JJ, Ulloa C, Perez JC, Giraud MN, et al. Non-steroidal anti-inflammatory drugs (NSAIDs) associate with zwitterionic phospholipids: insight into the mechanism and reversal of NSAID-induced gastrointestinal injury. Nat Med 1995;1:154-8.
20. Mahmud T, Scott DL, Bjarnason I. A unifying hypothesis for the mechanism of NSAID related gastrointestinal toxicity. Ann Rheum Dis 1996;55:211-3.
21. Pathan SA, Mitra B, Straney LD, Afzal MS, Anjum S, Shukla D, et al. Delivering safe and effective analgesia for management of renal colic in the emergency department: a double-blind, multigroup, randomised controlled trial. Lancet 2016;387:1999-2007.
22. Pouraghaei M, Moharamzadeh P, Paknezhad SP, Rajabpour ZV, Soleimanpour H. Intranasal ketamine versus intravenous morphine for pain management in patients with renal colic: a double-blind, randomized, controlled trial. World J Urol 2021;39:1263-7.
23. Bultitude M, Rees J. Management of renal colic. BMJ 2012;345:e5499.
24. Aydin ME, Tekin E, Ahiskalioglu EO, Ates I, Karagoz S, Aydin OF, et al. Erector spinae plane block vs non-steroidal anti-inflammatory drugs for severe renal colic pain: A pilot clinical feasibility study. Int J Clin Pract 2021;75:e13789.
25. Benyamin R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N, et al. Opioid complications and side effects. Pain Physician 2008;11:S105-20.
26. Shoag JE, Patel N, Posada L, Halpern JA, Stark T, Hu JC, et al. Kidney Stones and Risk of Narcotic Use. J Urol 2019;202:114-8.
27. Dungel P, Mittermayr R, Haindl S, Osipov A, Wagner C, Redl H, et al. Illumination with blue light reactivates respiratory activity of mitochondria inhibited by nitric oxide, but not by glycerol trinitrate. Arch Biochem Biophys 2008;471:109-15.
28. Liu T, Schroeder H, Power GG, Blood AB. A physiologically relevant role for NO stored in vascular smooth muscle cells: A novel theory of vascular NO signaling. Redox Biol 2022;53:102327.
29. Gibson A, Mirzazadeh S, Hobbs AJ, Moore PK. L-NG-monomethyl arginine and L-NG-nitro arginine inhibit non-adrenergic, non-cholinergic relaxation of the mouse anococcygeus muscle. Br J Pharmacol 1990;99:602-6.
30. Gillespie JS, Liu XR, Martin W. The effects of L-arginine and NG-monomethyl L-arginine on the response of the rat anococcygeus muscle to NANC nerve stimulation. Br J Pharmacol 1989;98:1080-2.
31. Ignarro LJ, Buga GM, Wood KS, Byrns RE, Chaudhuri G. Endothelium-derived relaxing factor produced and released from artery and vein is nitric oxide. Proc Natl Acad Sci U S A 1987;84:9265-9.
32. Chen Z, Zhang J, Stamler JS. Identification of the enzymatic mechanism of nitroglycerin bioactivation. Proc Natl Acad Sci U S A 2002;99:8306-11.
33. Kleschyov AL, Oelze M, Daiber A, Huang Y, Mollnau H, Schulz E, et al. Does nitric oxide mediate the vasodilator activity of nitroglycerin? Circ Res 2003;93:e104-12.
34. Núñez C, Víctor VM, Tur R, Alvarez-Barrientos A, Moncada S, Esplugues JV, et al. Discrepancies between nitroglycerin and NO-releasing drugs on mitochondrial oxygen consumption, vasoactivity, and the release of NO. Circ Res 2005;97:1063-9.
35. Asrress KN, Williams R, Lockie T, Khawaja MZ, De Silva K, Lumley M, et al. Physiology of Angina and Its Alleviation With Nitroglycerin: Insights From Invasive Catheter Laboratory Measurements During Exercise. Circulation 2017;136:24-34.
36. Ferreira JC, Mochly-Rosen D. Nitroglycerin use in myocardial infarction patients. Circ J 2012;76:15-21.
37. Scardi S, Pandullo C, Pivotti F, Ceschia G, Pollavini G. Hemodynamic and anti-angina effects of transdermal nitroglycerin after acute and chronic administration. Additive effect of sublingual isosorbide dinitrate. G Ital Cardiol 1986;16:895-903.
38. Groneberg D, Voussen B, Friebe A. Integrative Control of Gastrointestinal Motility by Nitric Oxide. Curr Med Chem 2016;23:2715-35.
39. Connolly C, Tierney S, Grace P. Systemic glyceryl trinitrate reduces anal sphincter tone: is there a therapeutic indication? Ir J Med Sci 2018;187:473-8.
40. Kaffes AJ, Bourke MJ, Ding S, Alrubaie A, Kwan V, Williams SJ. A prospective, randomized, placebo-controlled trial of transdermal glyceryl trinitrate in ERCP: effects on technical success and post-ERCP pancreatitis. Gastrointest Endosc 2006;64:351-7.
41. Sudhindran S, Bromwich E, Edwards PR. Prospective randomized double-blind placebo-controlled trial of glyceryl trinitrate in endoscopic retrograde cholangiopancreatography-induced pancreatitis. Br J Surg 2001;88:1178-82.
42. Talwar A, Dare C, Pain J. Does topical GTN on the sphincter of Oddi facilitate ERCP? A double-blind randomized control trial. Surg Endosc 2005;19:902-4.
43. Wehrmann T, Schmitt T, Stergiou N, Caspary WF, Seifert H. Topical application of nitrates onto the papilla of Vater: manometric and clinical results. Endoscopy 2001;33:323-8.
44. Wu SD, Zhang ZH, Li DY, Jin JZ, Kong J, Tian Z, et al. Nitroester drug's effects and their antagonistic effects against morphine on human sphincter of Oddi motility. World J Gastroenterol 2005;11:2319-23.
45. Gaston B, Drazen JM, Jansen A, Sugarbaker DA, Loscalzo J, Richards W, et al. Relaxation of human bronchial smooth muscle by S-nitrosothiols in vitro. J Pharmacol Exp Ther 1994;268:978-84.
46. García-Pascual A, Costa G, Labadía A, Jimenez E, Triguero D. Differential mechanisms of urethral smooth muscle relaxation by several NO donors and nitric oxide. Naunyn Schmiedebergs Arch Pharmacol 1999;360:80-91.
47. A.Razi A, Zargoosh J. Effect of sublingual nitroglycerine on pain relief in renal and ureteral colic. Med J Islam Repub Iran 1997;11:103-4.
48. Hofstetter AG, Kriegmair M. [Treatment of ureteral colic with glycerol trinitrate]. Fortschr Med 1993;111:286-8.
49. Hussain Z, Inman RD, Elves AW, Shipstone DP, Ghiblawi S, Coppinger SW. Use of glyceryl trinitrate patches in patients with ureteral stones: a randomized, double-blind, placebo-controlled study. Urology 2001;58:521-5.
50. Nasehi L, Taslimi R, Dehpour A, Seyedhosseini J. Pain Relieving Effect of Sublingual Glycerol Trinitrate in Renal Colic: a Randomized Placebo-Controlled Trial. Front Emerg Med 2018;2:e2.
51. Luman W, Pryde A, Heading RC, Palmer KR. Topical glyceryl trinitrate relaxes the sphincter of Oddi. Gut 1997;40:541-3.
52. Armstrong PW, Armstrong JA, Marks GS. Blood levels after sublingual nitroglycerin. Circulation 1979;59:585-8.
53. Iversen HH, Ehrén I, Gustafsson LE, Adolfsson J, Wiklund NP. Modulation of smooth muscle activity by nitric oxide in the human upper urinary tract. Urol Res 1995;23:391-4.
54. Lee YH, Lee WC, Chen MT, Huang JK, Chung C, Chang LS. Acupuncture in the treatment of renal colic. J Urol 1992;147:16-8.
55. Dubinsky I, Penciner R. Nitroglycerin and renal colic. Ann Emerg Med 1997;29:824-5.
56. Kekeç Z, Yilmaz U, Sözüer E. The effectiveness of tenoxicam vs isosorbide dinitrate plus tenoxicam in the treatment of acute renal colic. BJU Int 2000;85:783-5.
57. Kariman H, Majidi A, Taheri S, Shahrami A, Hatamabadi HR. Analgesic Effects of Inhalation of Nitric Oxide (Entonox) and Parenteral Morphine Sulfate in Patients with Renal Colic; A Randomized Clinical Trial. Bull Emerg Trauma 2015;3:46-52.
2. Moussa M, Papatsoris AG, Chakra MA. Intradermal sterile water injection versus diclofenac sodium in acute renal colic pain: A randomized controlled trial. Am J Emerg Med 2021;44:395-400.
3. Razi A, Farrokhi E, Lotfabadi P, Hosseini SS, Saadati H, Haghighi R, et al. Dexamethasone and ketorolac compare with ketorolac alone in acute renal colic: A randomized clinical trial. Am J Emerg Med 2022;58:245-50.
4. Tu JF, Cao Y, Wang LQ, Shi GX, Jia LC, Liu BL, et al. Effect of Adjunctive Acupuncture on Pain Relief Among Emergency Department Patients With Acute Renal Colic Due to Urolithiasis: A Randomized Clinical Trial. JAMA Netw Open 2022;5:e2225735.
5. Zolfaghari Sadrabad A, Azimi Abarghouei S, Farahmand Rad R, Salimi Y. Intravenous magnesium sulfate vs. morphine sulfate in relieving renal colic: A randomized clinical trial. Am J Emerg Med 2021;46:188-92.
6. Jang Y, Kim M, Hwang SW. Molecular mechanisms underlying the actions of arachidonic acid-derived prostaglandins on peripheral nociception. J Neuroinflammation 2020;17:30.
7. Ghani KR, Roghmann F, Sammon JD, Trudeau V, Sukumar S, Rahbar H, et al. Emergency department visits in the United States for upper urinary tract stones: trends in hospitalization and charges. J Urol 2014;191:90-6.
8. Pickard R, Starr K, MacLennan G, Lam T, Thomas R, Burr J, et al. Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Lancet 2015;386:341-9.
9. 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:e16222.
10. Holdgate A, Pollock T. Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic. BMJ 2004;328:1401.
11. Jalili M, Shirani F, Entezari P, Hedayatshodeh M, Baigi V, Mirfazaelian H. Desmopressin/indomethacin combination efficacy and safety in renal colic pain management: A randomized placebo controlled trial. Am J Emerg Med 2019;37:1009-12.
12. Maleki Verki M, Porozan S, Motamed H, Fahimi MA, Aryan A. Comparison the analgesic effect of magnesium sulphate and Ketorolac in the treatment of renal colic patients: Double-blind clinical trial study. Am J Emerg Med 2019;37:1033-6.
13. Mozafari J, Maleki Verki M, Motamed H, Sabouhi A, Tirandaz F. Comparing intranasal ketamine with intravenous fentanyl in reducing pain in patients with renal colic: A double-blind randomized clinical trial. Am J Emerg Med 2020;38:549-53.
14. Soleimanpour H, Hassanzadeh K, Vaezi H, Golzari SE, Esfanjani RM, Soleimanpour M. Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department. BMC Urol 2012;12:13.
15. Hamidi N, Ozturk E, Yikilmaz TN, Atmaca AF, Basar H. The effect of corticosteroid on postoperative early pain, renal colic and total analgesic consumption after uncomplicated and unstented ureteroscopy: a matched-pair analysis. World J Urol 2018;36:979-84.
16. Tsiotras A, Smith RD, Pearce I, O’Flynn K, Wiseman O. British Association of Urological Surgeons standards for management of acute ureteric colic. J Clin Urol 2018;11:58-61.
17. Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis. Eur Urol 2016;69:468-74.
18. Miller NL, Lingeman JE. Management of kidney stones. BMJ 2007;334:468-72.
19. Lichtenberger LM, Wang ZM, Romero JJ, Ulloa C, Perez JC, Giraud MN, et al. Non-steroidal anti-inflammatory drugs (NSAIDs) associate with zwitterionic phospholipids: insight into the mechanism and reversal of NSAID-induced gastrointestinal injury. Nat Med 1995;1:154-8.
20. Mahmud T, Scott DL, Bjarnason I. A unifying hypothesis for the mechanism of NSAID related gastrointestinal toxicity. Ann Rheum Dis 1996;55:211-3.
21. Pathan SA, Mitra B, Straney LD, Afzal MS, Anjum S, Shukla D, et al. Delivering safe and effective analgesia for management of renal colic in the emergency department: a double-blind, multigroup, randomised controlled trial. Lancet 2016;387:1999-2007.
22. Pouraghaei M, Moharamzadeh P, Paknezhad SP, Rajabpour ZV, Soleimanpour H. Intranasal ketamine versus intravenous morphine for pain management in patients with renal colic: a double-blind, randomized, controlled trial. World J Urol 2021;39:1263-7.
23. Bultitude M, Rees J. Management of renal colic. BMJ 2012;345:e5499.
24. Aydin ME, Tekin E, Ahiskalioglu EO, Ates I, Karagoz S, Aydin OF, et al. Erector spinae plane block vs non-steroidal anti-inflammatory drugs for severe renal colic pain: A pilot clinical feasibility study. Int J Clin Pract 2021;75:e13789.
25. Benyamin R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N, et al. Opioid complications and side effects. Pain Physician 2008;11:S105-20.
26. Shoag JE, Patel N, Posada L, Halpern JA, Stark T, Hu JC, et al. Kidney Stones and Risk of Narcotic Use. J Urol 2019;202:114-8.
27. Dungel P, Mittermayr R, Haindl S, Osipov A, Wagner C, Redl H, et al. Illumination with blue light reactivates respiratory activity of mitochondria inhibited by nitric oxide, but not by glycerol trinitrate. Arch Biochem Biophys 2008;471:109-15.
28. Liu T, Schroeder H, Power GG, Blood AB. A physiologically relevant role for NO stored in vascular smooth muscle cells: A novel theory of vascular NO signaling. Redox Biol 2022;53:102327.
29. Gibson A, Mirzazadeh S, Hobbs AJ, Moore PK. L-NG-monomethyl arginine and L-NG-nitro arginine inhibit non-adrenergic, non-cholinergic relaxation of the mouse anococcygeus muscle. Br J Pharmacol 1990;99:602-6.
30. Gillespie JS, Liu XR, Martin W. The effects of L-arginine and NG-monomethyl L-arginine on the response of the rat anococcygeus muscle to NANC nerve stimulation. Br J Pharmacol 1989;98:1080-2.
31. Ignarro LJ, Buga GM, Wood KS, Byrns RE, Chaudhuri G. Endothelium-derived relaxing factor produced and released from artery and vein is nitric oxide. Proc Natl Acad Sci U S A 1987;84:9265-9.
32. Chen Z, Zhang J, Stamler JS. Identification of the enzymatic mechanism of nitroglycerin bioactivation. Proc Natl Acad Sci U S A 2002;99:8306-11.
33. Kleschyov AL, Oelze M, Daiber A, Huang Y, Mollnau H, Schulz E, et al. Does nitric oxide mediate the vasodilator activity of nitroglycerin? Circ Res 2003;93:e104-12.
34. Núñez C, Víctor VM, Tur R, Alvarez-Barrientos A, Moncada S, Esplugues JV, et al. Discrepancies between nitroglycerin and NO-releasing drugs on mitochondrial oxygen consumption, vasoactivity, and the release of NO. Circ Res 2005;97:1063-9.
35. Asrress KN, Williams R, Lockie T, Khawaja MZ, De Silva K, Lumley M, et al. Physiology of Angina and Its Alleviation With Nitroglycerin: Insights From Invasive Catheter Laboratory Measurements During Exercise. Circulation 2017;136:24-34.
36. Ferreira JC, Mochly-Rosen D. Nitroglycerin use in myocardial infarction patients. Circ J 2012;76:15-21.
37. Scardi S, Pandullo C, Pivotti F, Ceschia G, Pollavini G. Hemodynamic and anti-angina effects of transdermal nitroglycerin after acute and chronic administration. Additive effect of sublingual isosorbide dinitrate. G Ital Cardiol 1986;16:895-903.
38. Groneberg D, Voussen B, Friebe A. Integrative Control of Gastrointestinal Motility by Nitric Oxide. Curr Med Chem 2016;23:2715-35.
39. Connolly C, Tierney S, Grace P. Systemic glyceryl trinitrate reduces anal sphincter tone: is there a therapeutic indication? Ir J Med Sci 2018;187:473-8.
40. Kaffes AJ, Bourke MJ, Ding S, Alrubaie A, Kwan V, Williams SJ. A prospective, randomized, placebo-controlled trial of transdermal glyceryl trinitrate in ERCP: effects on technical success and post-ERCP pancreatitis. Gastrointest Endosc 2006;64:351-7.
41. Sudhindran S, Bromwich E, Edwards PR. Prospective randomized double-blind placebo-controlled trial of glyceryl trinitrate in endoscopic retrograde cholangiopancreatography-induced pancreatitis. Br J Surg 2001;88:1178-82.
42. Talwar A, Dare C, Pain J. Does topical GTN on the sphincter of Oddi facilitate ERCP? A double-blind randomized control trial. Surg Endosc 2005;19:902-4.
43. Wehrmann T, Schmitt T, Stergiou N, Caspary WF, Seifert H. Topical application of nitrates onto the papilla of Vater: manometric and clinical results. Endoscopy 2001;33:323-8.
44. Wu SD, Zhang ZH, Li DY, Jin JZ, Kong J, Tian Z, et al. Nitroester drug's effects and their antagonistic effects against morphine on human sphincter of Oddi motility. World J Gastroenterol 2005;11:2319-23.
45. Gaston B, Drazen JM, Jansen A, Sugarbaker DA, Loscalzo J, Richards W, et al. Relaxation of human bronchial smooth muscle by S-nitrosothiols in vitro. J Pharmacol Exp Ther 1994;268:978-84.
46. García-Pascual A, Costa G, Labadía A, Jimenez E, Triguero D. Differential mechanisms of urethral smooth muscle relaxation by several NO donors and nitric oxide. Naunyn Schmiedebergs Arch Pharmacol 1999;360:80-91.
47. A.Razi A, Zargoosh J. Effect of sublingual nitroglycerine on pain relief in renal and ureteral colic. Med J Islam Repub Iran 1997;11:103-4.
48. Hofstetter AG, Kriegmair M. [Treatment of ureteral colic with glycerol trinitrate]. Fortschr Med 1993;111:286-8.
49. Hussain Z, Inman RD, Elves AW, Shipstone DP, Ghiblawi S, Coppinger SW. Use of glyceryl trinitrate patches in patients with ureteral stones: a randomized, double-blind, placebo-controlled study. Urology 2001;58:521-5.
50. Nasehi L, Taslimi R, Dehpour A, Seyedhosseini J. Pain Relieving Effect of Sublingual Glycerol Trinitrate in Renal Colic: a Randomized Placebo-Controlled Trial. Front Emerg Med 2018;2:e2.
51. Luman W, Pryde A, Heading RC, Palmer KR. Topical glyceryl trinitrate relaxes the sphincter of Oddi. Gut 1997;40:541-3.
52. Armstrong PW, Armstrong JA, Marks GS. Blood levels after sublingual nitroglycerin. Circulation 1979;59:585-8.
53. Iversen HH, Ehrén I, Gustafsson LE, Adolfsson J, Wiklund NP. Modulation of smooth muscle activity by nitric oxide in the human upper urinary tract. Urol Res 1995;23:391-4.
54. Lee YH, Lee WC, Chen MT, Huang JK, Chung C, Chang LS. Acupuncture in the treatment of renal colic. J Urol 1992;147:16-8.
55. Dubinsky I, Penciner R. Nitroglycerin and renal colic. Ann Emerg Med 1997;29:824-5.
56. Kekeç Z, Yilmaz U, Sözüer E. The effectiveness of tenoxicam vs isosorbide dinitrate plus tenoxicam in the treatment of acute renal colic. BJU Int 2000;85:783-5.
57. Kariman H, Majidi A, Taheri S, Shahrami A, Hatamabadi HR. Analgesic Effects of Inhalation of Nitric Oxide (Entonox) and Parenteral Morphine Sulfate in Patients with Renal Colic; A Randomized Clinical Trial. Bull Emerg Trauma 2015;3:46-52.
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| Issue | Vol 63 No 4 (2025) | |
| Section | Original Articles | |
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| Glycerol Trinitrate renal colic visual analogue scale emergency department | ||
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How to Cite
1.
Ramezany PS, Shadram MA, Dehpour AR, Mohammad Jafari R, Saeedi M, Aghili M, Seyedhosseini J. Investigating the Analgesic Effect of Sublingual Glycerol Trinitrate (GTN) Spray as an Alternative Treatment in Renal Colic Pain: A Triple-Blinded Randomized Controlled Trial. Acta Med Iran. 2025;63(4):255-263.
