Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic

• Published in: BMJ Vol. 328; no. 7453; pp. 1401 - 1404
• Main Authors: Holdgate, Anna, Pollock, Tamara
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 12.06.2004; BMJ Publishing Group; British Medical Association; BMJ Publishing Group LTD; BMJ Publishing Group Ltd
• Edition: International edition
• Subjects: Analgesia; Analgesia - methods; Analgesics; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Biological and medical sciences; Colic - drug therapy; Cross cultural studies; Experimentation; Humans; Illnesses; Kidney Diseases - drug therapy; Medical sciences; Medical treatment; Narcotics - therapeutic use; Nephrology. Urinary tract diseases; Nonsteroidal antiinflammatory agents; Opioid analgesics; Pain; Pain Measurement; Patient Satisfaction; Pharmaceuticals; Randomized Controlled Trials as Topic; Renal colic; Sodium; Treatment Outcome; Urinary lithiasis; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Vomiting; Human; Urinary system disease; Acute; Systematic review; Urinary tract disease; Review; Urinary stone; Non steroidal antiinflammatory agent; Medicine; Analgesic; Treatment; Renal colic; Lithiasis; Bibliographic review
• ISSN: 0959-8138; 0959-8146; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.38119.581991.55

Abstract Objective To examine the relative benefits and disadvantages of non-steroidal anti-inflammatory drugs (NSAIDs) and opioids for the management of acute renal colic. Data sources Cochrane Renal Group's specialised register, Cochrane central register of controlled trials, Medline, Embase, and reference lists of retrieved articles. Review methods Randomised controlled trials comparing any opioid with any NSAID in acute renal colic if they reported any of the following outcomes: patient rated pain, time to pain relief, need for rescue analgesia, rate of recurrence of pain, and adverse events. Results 20 trials totalling 1613 participants were identified. Both NSAIDs and opioids led to clinically important reductions in patient reported pain scores. Pooled analysis of six trials showed a greater reduction in pain scores for patients treated with NSAIDs than with opioids. Patients treated with NSAIDs were significantly less likely to require rescue analgesia (relative risk 0.75, 95% confidence interval 0.61 to 0.93). Most trials showed a higher incidence of adverse events in patients treated with opioids. Compared with patients treated with opioids, those treated with NSAIDs had significantly less vomiting (0.35, 0.23 to 0.53). Pethidine was associated with a higher rate of vomiting. Conclusions Patients receiving NSAIDs achieve greater reductions in pain scores and are less likely to require further analgesia in the short term than those receiving opioids. Opioids, particularly pethidine, are associated with a higher rate of vomiting.