CLINICAL QUESTION: Are intravenous nonsteroidal anti-inflammatory drugs (NSAIDs) more effective than narcotics for the treatment of patients with acute renal colic?
STUDY DESIGN: Meta-analysis (randomized controlled trials)
SETTING: Various (meta-analysis)
SYNOPSIS: The authors of this study scoured nephrology textbooks, review articles, study bibliographies, conference proceedings, and 4 databases to find the 20 trials that compared (usually) intravenous NSAIDs with opioids for a total of 1613 patients with acute renal colic. The authors didn’t describe how this search was performed or how articles were selected for inclusion.
Of the 9 trials that evaluated pain at a fixed time after therapy was given, pain reports were slightly but significantly lower in the NSAID group. Studies with ketorolac (Toradol) produced heterogeneous results, but other NSAIDs produced scores that were lower, on average, by 4.6 mm on a 100-mm visual analog scale (a difference of 13 mm to 15 mm is considered clinically relevant).
The number of patients with complete pain relief at 30 or 60 minutes was similar in the 2 groups. However, the risk of patients requiring rescue (ie, additional) analgesia was significantly less in the NSAID group (relative risk=0.75; 95% confidence interval [CI], 0.61–0.93).
Approximately 16 patients treated with an NSAID instead of a narcotic (9 of 10 trials used meperidine [Demerol]) would need to be treated for 1 additional patient to avoid the need for additional analgesia (number needed to treat=16; 95% CI, 10–57).
Vomiting occurred less often with NSAIDs than with narcotic treatment (relative risk = 0.35; 95% CI, 0.23–0.53), with 1 fewer patient vomiting for every 8 patients treated with an NSAID instead of an opioid (95% CI, 7–11). Vomiting risk was highest with meperidine.
The effect of the type of analgesia on the duration of colic was not evaluated in these studies, although their pharmacology would suggest NSAIDs, by causing relaxation of the greeters, would produce more rapid resolution.