Intradermal sterile water injection for “>American Journal of Emergency Medicine 38 (2020) 1938

Letter to the editor

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Intradermal sterile water injection for acute renal colic pain

To the Editors,

In this letter, we would like to comment on the study entitled “Intra- dermal sterile water injection versus Diclofenac sodium in acute renal colic pain: A randomized controlled trial.” [1]. The established data re- lated to subcutaneous distilled water injection in renal colic pain condi- tion have been presented during the European Association of Urology Congress, which was held in Istanbul, Turkey in 2005 [2]. Besides, we have published a retrospective study paper on this method, which we have been applying for about 15 years [3]. We prefer to use the method firstly introduced by Martensson et al. [4]. In this approach, four distinct sites are determined for injection-induced papule formation instead of one site. The superior aspect of the method by Martensson et al. is that the renal colic pain is effectively blocked in a way that has been de- scribed in Melzack theory. According to this theory, consecutive injec- tions increase the pain threshold, which in turn competitively block and mask the current renal colic pain carried by the afferent sensory neuronal pathway to the brain. Especially, this effect is more prominent after the formation of temporal summation following the third and fourth papule formations (Photo). This injection-induced pain feeling is so terrible so that, even some patients with renal colic refuse to re- ceive this treatment again in case of a recurrency [3].

References

1. 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. 2020. https://doi.org/10.1016/j.ajem.2020.04.079 In Press, Corrected Proof, Available online 29 April.
2. Aras B, Uruc F, Ercelik H, Korkmaz M, Sevim M, Yucel M. Investigation of the effect of intracutane ous sterile water injection: a rapid and effective approach in urolithiasis- related renal colic treat ment. The New Journal of Urology. 2017;12(3):35-9.
3. Sigirci AR, Seymen T, Karadag S, Aras B, et al. Comparison of Diclofenac Sodium and

   Intracutane Sterile Water Injections in Renal Colic: A Randomized Trial. , 20EAU Congress-Istanbul; 2005 Turkey.

   Martensson L, Nyberg K, Wallin G. Subcutaneous versus intracutaneous injections of sterile water for labour analgesia: a comparison of perceived pain during administra- tion. Br J Obst Gynecol. 2000;107:1248-51.

   Bekir Aras

   Kutahya Health Sciences University, Faculty of Medicine, Department of

   Urology, Kutahya, Turkey

   Corresponding author.

   E-mail address: [email protected]

   Fatih Uruc

   Bahcesehir University, Faculty of Medicine, Department of Urology,

   Istanbul, Turkey

   2 June 2020

   https://doi.org/10.1016/j.ajem.2020.06.047

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