Randomized double blinded placebo controlled trial comparing diclofenac and piroxicam in management of acute renal colic and its clinical implications.
OBJECTIVE
To compare the efficacy of sublingual piroxicam 40 mg with intramuscular diclofenac 75 mg in treatment of acute renal colic. The secondary objective was to look for factors that can affect the severity of the pain and pain relief in acute renal colic.


METHODS
One hundred patients with acute renal colic were randomized into two groups. Group A (n = 50) received intramuscular diclofenac and sublingual methylcobalamin. Group B (n = 50) received sublingual piroxicam 40 mg and intramuscular distilled water. Pain severity was measured using Visual Analog Scale (VAS) and verbal and facial response scales. They were followed up for 3 h. Intramuscular injection of pentazocine 30 mg with promethazine 25 mg were used as rescue drugs.


RESULTS
Both groups were comparable for age, sex distribution, body mass index (BMI), and pain duration before presentation. Significant pain relief was noticed in both groups. Sixteen percent in group A and 18% in group B had complete pain relief within 30 min (P = .75). Fifteen patients in group A and 13 patients in group B needed rescue drugs, 84% of group A and 76% of group B had complete pain relief at the end of 3 hours (P = .25). Decrease in pain by each scoring method was also comparable (P = .75). In multiple regression analysis, increasing age, positively affects the severity of pain and pain relief while increasing BMI negatively affect the initial pain relief. Acute renal colic seems to affect men more commonly than women, 81% of the study population were men. Patients with low initial pain score did not require any additional pain relief. Average pain duration before presenting to hospital is 260 min. Sixty percent of renal colics are due to stones below pelvic brim.


CONCLUSIONS
The results show that sublingual piroxicam is as effective as intramuscular diclofenac. It can be easily self-administered and it overcomes the morbidity and time delay in getting intramuscular diclofenac.
Dudley Group Hospitals NHS Foundation Trust, Dudley-DY1 2HQ, West Midlands, UK. kgvignesh@yahoo.com.
Gokul Vignesh
GV
KandaSwamy
Queen Elizabeth University Hospital, Birmingham, UK.
Ananda Kumar
AK
Dhanasekaran
Dharan Hospital, Salem, India.
Aravindhan
A
Elangovan
Department of Urology Malankara Orthodox Syrian Church Medical College, Kolenchery, India.
Bobby
B
John
Vedanayagam Hospital Private Limited, Coimbatore, India.
Bobby
B
Viswaroop
Department of Urology Vedanayagam Hospital, Private Limited, Coimbatore, India.
Kandasami Sangam
KS
Vedanayagam
D000208:Acute Disease; D000286:Administration, Sublingual; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D004008:Diclofenac / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010147:Pain Measurement; D010894:Piroxicam / Q000008:administration & dosage*; D056844:Renal Colic / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
D000894:Anti-Inflammatory Agents, Non-Steroidal; D010894:Piroxicam; D004008:Diclofenac