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Acute Pain | Chronic Pain | General

NSAIDs and acute renal colic

Clinical bottom line:

Based on a small dataset, diclofenac 75 mg (intramuscular) is better than placebo at completely relieving pain from renal colic.

No other comparisons were possible.


NSAIDs and acute renal colic

A wide range of drugs are used in the emergency treatment of nephrolithiasis (renal colic). In North America standard treatment is parenteral narcotic analgesic therapy. European treatments include use of antispasmodic agents, narcotic and non-narcotic analgesics and, more recently, non-steroidal anti-inflammatory drugs (NSAIDs). It has been argued that NSAIDs are the preferred treatment as they are associated with fewer side effects.

Systematic review

Labrecque M, Dostaler LP, Rousselle R, Nguyen T, Poirier S. Efficacy of nonsteroidal anti-inflammatory drugs in the treatment of acute renal colic. A meta-analysis. Arch Intern Med 1994; 154:1381-7.

Inclusion criteria were randomised controlled trials comparing and NSAID with placebo or other analgesic agent; emergency treatment of acute renal colic; English or French language. Included trials were not all double-blind.

Relative benefits were calculated for each trial (95% confidence interval). Authors regarded a relative benefit of greater than 1.25 to be clinically significant. Different drug doses and routes of administration were lumped together.

Findings

Thirteen trials examined intramuscular diclofenac, and one trial examined rectal diclofenac. Six trials examined intravenous indoprofen, and two trials looked at intramuscular ketorolac. Active controls were spasmofen, scopolamine, prochlorperazine, avafortan, meperidine, dipyrone, ketogan, baralgan, hydromorphone with atropine, proclorperazine, metamizole, papaverine and oxycodone.

It is not possible to combine trials with different routes of administration, different drug doses, or different active controls as has been done with this review. Results presented below are of the trials where combination was possible.

NSAID versus placebo

Two trials looked at diclofenac 75 mg (intramuscular) versus placebo, with 85 diclofenac patients and 96 placebo patients. Both trials found that diclofenac was significantly superior to placebo in completely relieving pain. A further trial with this comparison is reported. Outcome is not reported.

NSAIDs versus other analgesic

It is not possible to combine data from these trials since active control conditions have varying doses and/or agents. Two trials compared diclofenac 75 mg (intramuscular) with dipyrone 2 g (intramuscular). Trial outcomes were not broken down by the reviewers to enable a comparison.

Adverse effects

The review did not cover adverse effects.

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