Original Article: Effects of adding oral clonidine to standard treatments on pain intensity of patients with acute renal colic: A randomized clinical trial


1 Department of Emergency Medicine, School of Medicine, Al‑Zahra Hospital, Isfahan University of Medical Sciences

2 Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran


Background: The aim of this study was to compare the effect of adding oral clonidine to standard treatments on pain intensity in patients with acute renal colic. Materials and Methods: This is a randomized clinical trial that was performed in 2020 in Isfahan. The study population consisted of 200 patients with renal colic. Pain of the patients was assessed using Visual Analog Scale. Patients were then randomized into 4 groups of 50 patients. Group A received 0.1 mg/kg morphine and clonidine tablets (0.2 mg). Group B received morphine and placebo. Group C received 30 mg ketorolac and clonidine tablets. Group D received 30 mg ketorolac and placebo tablets. Pain of patients was assessed. 0.05 mg/kg morphine was administered and repeated every 40 min if the pain was not reduced. Results: Our data showed that there was a significant difference between pains of patient by the time of admission in groups (P = 0.04). However, no significant differences were observed between pains of patients in different measuring times (P > 0.05). Using general linear model, we showed that the decreases in pain scores of each group were significant (P < 0.05) but there were no significant differences in pains of patients in different measuring times (P > 0.05). Our data showed that Group A and Group C had lowest frequencies of morphine administrations while Groups B and D had the highest frequencies (P < 0.001). Conclusion: We showed that administration of clonidine in patients with renal colic resulted in better pain control and lower morphine injections.


Farnia MR, Jalali A, Vahidi E, Momeni M, Seyedhosseini J, Saeedi M. Comparison of intranasal ketamine versus IV morphine in reducing pain in patients with renal colic. Am J Emerg Med 2017;35:434-7.  Back to cited text no. 1
Ye Z, Zeng G, Yang H, Tang K, Zhang X, Li H, et al. Efficacy and safety of tamsulosin in medical expulsive therapy for distal ureteral stones with renal colic: A multicenter, randomized, double-blind, placebo-controlled trial. Eur Urol 2018;73:385-91.  Back to cited text no. 2
Mahamat MA, Diarra A, Kassogué A, Eyongeta D, Valentin V, Allah-Syengar N, et al. Renal colic: Epidemiological, clinical etiological and therapeutic aspects at the urology department of the national reference general hospital of n'djamena (Chad). Open J Urol 2020;10:25.  Back to cited text no. 3
Sohgaura A, Bigoniya P. A review on epidemiology and etiology of renal stone. Am J Drug Discov Dev 2017;7:54-62.  Back to cited text no. 4
Aggarwal R, Srivastava A, Jain SK, Sud R, Singh R. Renal stones: A clinical review. EMJ Urol 2017;5:98-103.  Back to cited text no. 5
Busse JW, Wang L, Kamaleldin M, Craigie S, Riva JJ, Montoya L, et al. Opioids for chronic noncancer pain: A systematic review and meta-analysis. JAMA 2018;320:2448-60.  Back to cited text no. 6
Gu HY, Luo J, Wu JY, Yao QS, Niu YM, Zhang C. Increasing nonsteroidal anti-inflammatory drugs and reducing opioids or paracetamol in the management of acute renal colic: Based on three-stage study design of network meta-analysis of randomized controlled trials. Front Pharmacol 2019;10:96.  Back to cited text no. 7
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.  Back to cited text no. 8
Pathan SA, Mitra B, Cameron PA. A systematic review and meta-analysis comparing the efficacy of nonsteroidal anti-inflammatory drugs, opioids, and paracetamol in the treatment of acute renal colic. Eur Urol 2018;73:583-95.  Back to cited text no. 9
Sotoodehnia M, Farmahini-Farahani M, Safaie A, Rasooli F, Baratloo A. Low-dose intravenous ketamine versus intravenous ketorolac in pain control in patients with acute renal colic in an emergency setting: a double-blind randomized clinical trial. Korean J Pain 2019;32:97.  Back to cited text no. 10
Adegboye MB, Kolawole IK, Bolaji BO. Dose related effects of oral clonidine pre-medication on bupivacaine spinal anaesthesia. Afr Health Sci 2018;18:1283-91.  Back to cited text no. 11
Krieger EM, Drager LF, Giorgi DMA, Pereira AC, Barreto-Filho JA, Nogueira AR, et al. Spironolactone versus clonidine as a fourth-drug therapy for resistant hypertension: The ReHOT randomized study (resistant hypertension optimal treatment). Hypertension 2018;71:681-90.  Back to cited text no. 12
Hsu YP, Chu KC, Bai CH, Huang CJ, Chen C, Hsu CW. Safety and efficacy of clonidine on postoperative vomiting and pain in pediatric ophthalmic surgery: A systematic review and meta-analysis. Pediatr Anesth 2019;29:1011-23.  Back to cited text no. 13
Masud M, Yeasmeen S, Haque AK, Jahan S, Saha NC, Banik D. Role of oral clonidine premedication on intra-operative haemodynamics and PONV in laparoscopic cholecystectomy. Mymensingh Med J 2017;26:913-20.  Back to cited text no. 14
Caumo W, Levandovski R, Hidalgo MP. Preoperative anxiolytic effect of melatonin and clonidine on postoperative pain and morphine consumption in patients undergoing abdominal hysterectomy: A double-blind, randomized, placebo-controlled study. J Pain 2009;10:100-8.  Back to cited text no. 15
Singh R, Gupta D, Jain A. The effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain after lower segment caesarean section: A randomized control trial. Saudi J Anaesth 2013;7:283-90.  Back to cited text no. 16
van Tuijl I, van Klei WA, van der Werff DB, Kalkman CJ. The effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain and morphine requirements after Caesarean section: A randomized controlled trial. Br J Anaesth 2006;97:365-70.  Back to cited text no. 17
Naja ZM, Khatib R, Ziade FM, Moussa G, Naja ZZ, Naja AS, et al. Effect of clonidine versus dexmedetomidine on pain control after laparoscopic gastric sleeve: A prospective, randomized, double-blinded study. Saudi J Anaesth 2014;8:S57-62.  Back to cited text no. 18
Huang YS, Lin LC, Huh BK, Sheen MJ, Yeh CC, Wong CS, et al. Epidural clonidine for postoperative pain after total knee arthroplasty: A dose-response study. Anesth Analg 2007;104:1230-5, tables of contents.  Back to cited text no. 19
Campbell CM, Kipnes MS, Stouch BC, Brady KL, Kelly M, Schmidt WK, et al. Randomized control trial of topical clonidine for treatment of painful diabetic neuropathy. Pain 2012;153:1815-23.  Back to cited text no. 20
Forouzanfar MM, Mohammadi K, Hashemi B, Safari S. Comparison of intravenous ibuprofen with intravenous ketorolac in renal colic pain management; A clinical trial. Anesth Pain Med 2019;9:e86963.  Back to cited text no. 21
Hosseininejad SM, Ahidashti HA, Bozorgi F, Khatir IG, Montazar SH, Jahanian F, et al. Efficacy and safety of combination therapy with ketorolac and morphine in patient with acute renal colic; A triple-blind randomized controlled clinical trial. Bull Emerg Trauma 2017;5:165.