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NSAIDs Better Than Opioids for Acute Renal Colic

In a systematic review, NSAIDs achieved better pain relief with less need for rescue analgesia and less vomiting.

Opioids have played a long-standing role in pain relief for acute renal colic, but nonsteroidal anti-inflammatory drugs (NSAIDs) -- by virtue of inhibiting prostaglandins -- affect a basic pathway that might well mediate pain in this setting. Although studies have been done in which the two types of medication were compared, agreement is lacking as to which is preferred, leading to this systematic review.

Investigators identified 20 randomized controlled trials involving 1613 people with acute renal colic. Patients in 9 trials reported pain levels on a visual analog scale; in 7 of the trials, patients favored treatment with NSAIDs. Nine trials reported the proportion of patients who failed to achieve complete pain relief at 30 or 60 minutes; although no study favored one drug over the other, pooled analysis showed a trend that favored NSAIDs. In 10 trials that reported patients' need for additional ("rescue") analgesia within 4 hours of receiving the study drug, patients who received NSAIDs were significantly less likely than those who received opioids (usually meperidine [Demerol]; relative risk, 0.75) to require rescue drugs. Heterogeneity among the studies precluded analysis of adverse events, except for vomiting, which was reported in 10 trials; significantly less vomiting occurred among patients who received NSAIDs than among those who received opioids (RR, 0.35).

Comment: This systematic review shows that, for this indication, NSAIDs achieve slightly better pain relief, reduce need for rescue analgesia, and produce much less vomiting than do opioids. These conclusions should be enough to recommend NSAIDs as first-line analgesics in patients with acute renal colic. At the time of publication, the full text of the original article was available free of charge.

— Keith I. Marton, MD

Published in Journal Watch General Medicine July 20, 2004

Citation(s):

Holdgate A and Pollock T. Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic. BMJ 2004 Jun 12; 328:1401-4.

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