Soleimanpour et al. Journal of Medical Case Reports 2011, 5:256 http://www.jmedicalcasereports.com/content/5/1/256 Page 2 of 4 Table 1 Visual Analog Scale score at each 10-minute intervala Mean VAS score ± SD aVAS, Visual Analog Scale; SD, standard deviation; 95% CI, 95% confidence interval. Before treatment 8.87 ± 0.99 (95% CI 8.04 to 9.70) 10 minutes after treatment 20 minutes after treatment 30 minutes after treatment 1.75 ± 2.18 (95% CI -0.07 to 3.57) 1.25 ± 2.81 (95% CI -1.10 to 3.60) 1 ± 2.82 (95% CI -1.36 to 3.36) -1.36 to 3.36) before and 30 minutes after receiving lido- caine treatment, respectively. Colic pain disappeared com- pletely within 10, 20, and 30 minutes in four of eight, six of eight, and seven of eight patients, respectively. The vital signs of the patients did not change during the 30 minutes. Two of eight patients experienced transient mild dizziness, and three of eight patients experienced minimal slurring of speech. No patients experienced serious adverse events. One patient needed another anodyne treatment after 30 minutes. For further studies, a kidney, ureter, and bladder (KUB) X-ray was requested immediately for the patient who was resistant to lidocaine. However, for the other patients who had responded to lidocaine treatment, KUB X-rays with previous preparation were requested, and the results are presented in Table 2. Complete pain relief was reported in seven of eight patients after lidocaine adminis- tration, and this lasted until hospital discharge. These patients were followed up by telephone for the following 24 hours. To reduce the risk of stone recurrence, all patients were instructed to force oral hydration to produce at least 2L/day urine after discharge from the emergency room. Six of the patients reported that their renal colic had not come back during the previous 24 hours, but one patient who experienced renal colic rated his pain as 3 of 10 on the VAS. His pain was relieved by NSAID therapy. Case 1 was a 31-year-old Iranian woman who was referred to our emergency department because of refrac- tory renal colic (resistant to morphine and NSAIDs). The patient had a history of renal colic, and, in spite of receiving morphine and NSAIDS previously, she men- tioned no decrease in her degree of pain (VAS score 10 of 10). Her clinical examination revealed tenderness in her left costovertebral angle (CVA) radiating to the gen- italia, which was associated with dysuria, urination fre- quency, and nausea. Abundant RBCs were detected by Table 2 Individual patient characteristics urinalysis, and moderate hydronephrosis of the left kid- ney was visualized by ultrasonography. After obtaining written consent from the patient, lidocaine 1.5 mg/kg was administered intravenously. Ten, twenty, and thirty minutes after lidocaine treatment, the patient’s VAS scores decreased to 3 of 10, 0 of 10, and 0 of 10, respec- tively. After lidocaine administration, the patient experi- enced transient dizziness for less than one minute. The patient was followed up in the hospital until she was discharged. Follow-up was carried out by telephone for more than 24 hours after discharge. The patient experi- enced no colic pain during the follow-up period. On a planned KUB X-ray requested the day after her dis- charge from the emergency ward, a radiopaque stone was observed. Case 2 was a 32-year-old Iranian man who was referred to our emergency department because of refractory renal colic (resistant to morphine and NSAIDs). Despite the fact that he had previously received treatment with mor- phine and NSAIDs, he mentioned no regression in pain degree (VAS score 9 of 10). His clinical examination revealed tenderness in his right CVA radiating to the genitalia, which was associated with dysuria, hematuria, nausea, and vomiting. Abundant RBCs were revealed by urinalysis, and moderate hydronephrosis of his right kid- ney was visualized by ultrasonography. After obtaining written consent from the patient, lidocaine 1.5 mg/kg was administered intravenously. Ten, twenty, and thirty minutes after lidocaine treatment, the patient’s VAS scores decreased to 2 of 10, 0 of 10, and 0 of 10, respec- tively. The patient experienced transient dizziness and slurring of speech lasting less than one minute after lido- caine administration. He was followed up in the hospital until he was discharged. The follow-up procedure was continued by telephone for more than 24 hours after Case Age, years Gender Kind of Stone Stone side Stone condition Hydronephrosis 1 2 3 4 5 6 7 8 31 32 38 28 42 35 36 35 RS:Recurrent Stone; FS:First Stone. F M M F M M M M Radiopaque Radiopaque Radiopaque Radiolucent Radiopaque Radiopaque Radiopaque Radiolucent Left Right Left Right Left Left Right Right RS FS RS FS FS FS FS RS Moderate Moderate Mild Mild Moderate Moderate Moderate Mild