PACU High-Impact Studies Review – February 2025
Stay updated with the latest breakthrough research in emergency medicine, critical care, and advanced therapeutics.
1. Magnesium Sulfate vs. Lidocaine as an Adjunct for Renal Colic
This randomized, double-blind controlled trial compared intravenous (IV) magnesium sulfate (MgSO₄) and lidocaine as adjuncts to diclofenac for managing acute renal colic in the emergency department.
Methodology:
- Patients with moderate-to-severe renal colic were randomized into three groups: MgSO₄ + diclofenac, Lidocaine + diclofenac, or diclofenac alone.
- Pain scores and adverse events were recorded at multiple intervals.
Key Findings:
- MgSO₄ + diclofenac provided superior pain relief vs. lidocaine and control.
- Difference in pain reduction did not reach clinical significance for routine use.
- More adverse effects (nausea, flushing) in the MgSO₄ group.
Clinical Implications:
- Use MgSO₄ cautiously, balancing marginal benefits with adverse event risks.
- Lidocaine showed no major benefit over diclofenac alone.
2. Intranasal Ketamine as an Adjunct to Fentanyl for Prehospital Trauma
Pain
Assessed whether intranasal ketamine (IN ketamine) combined with fentanyl improves pain relief in out-of-hospital trauma vs. fentanyl alone.
Methodology:
- Paramedics administered either IN ketamine + fentanyl or fentanyl alone for acute traumatic pain.
- Pain scores, vital signs, and adverse events were tracked through hospital arrival.
Key Findings:
- No significant improvement in pain scores with ketamine + fentanyl over fentanyl alone.
- More adverse effects in the ketamine group (dizziness, nausea, dissociation).
Clinical Implications:
- IN ketamine does not significantly enhance pain control when added to fentanyl.
- Higher adverse events raise concerns about prehospital use.
3. Transfusion Practices in Traumatic Brain Injury (TBI): A Systematic
Review & Meta-Analysis
Explored whether liberal blood transfusion strategies improve neurologic outcomes in TBI patients.
Methodology:
- Compared liberal transfusion (Hb ≥9 g/dL) vs. restrictive transfusion (~7 g/dL) in RCTs.
- Assessed neurologic outcomes, mortality, complications (ARDS, blood utilization).
Key Findings:
- Liberal transfusions associated with better neurologic outcomes.
- Increased ARDS risk & higher blood usage.
Clinical Implications:
- Liberal transfusions may benefit severe TBI but come with increased risks.
- Guidelines may shift to a 9 g/dL threshold.