Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic.
OBJECTIVE
To examine the relative benefits and disadvantages of non-steroidal anti-inflammatory drugs (NSAIDs) and opioids for the management of acute renal colic.


METHODS
Cochrane Renal Group's specialised register, Cochrane central register of controlled trials, Medline, Embase, and reference lists of retrieved articles.


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.
Holdgate
Anna
A
Department of Emergency Medicine, St George Hospital, Gray St, Kogarah, NSW 2217, Australia. holdgatean@sesahs.nsw.gov.au
Pollock
Tamara
T
D000698:Analgesia / Q000379:methods; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D003085:Colic / Q000188:drug therapy*; D006801:Humans; D007674:Kidney Diseases / Q000188:drug therapy*; D009294:Narcotics / Q000627:therapeutic use*; D010147:Pain Measurement; D017060:Patient Satisfaction; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D009294:Narcotics