Clinical Question Are nonsteroida...

Clinical Question

Are nonsteroidal anti-inflammatory medicines (NSAIDs) or opiates more effective for pain relief in patients with acute renal colic?

Evidence-Based Answer

Data from randomized controll trials comparing NSAIDs with opiates point out to that NSAIDs are associated with lower pain scores, les ne for additional deliver medication, and less vomiting (particularly when compared with meperidine).

Practice Pointers

Acute renal colic is united of the most painful conditions and repeatedly is associated with nausea and vomiting. Holdgate and Pollock identified studies that compared NSAIDs with opiates in adults with acute renal colic (fewer than 12 hours' duration) and moderate to strict pain. They found 20 studies that included a total of 1613 patients and compared a total of five NSAIDs and five opiates (each meditation compared one opiate with individual NSAID).

Study quality was mediocre; although principally studies blinded either patients or result assessors during the study period, barely five studies clearly concealed allocation at the start of the application of mind and only three definitely used intention-to-treat analysis. Data from the trials could not be combined statistically because of differences in methodology and wide variability in results

Pain scores were reported in 13 studies. Ten studies build that patients who took NSAIDs had lower pain scores; couple studies found no difference, and individual study reported lower pain scores in patients who took opiates. There was no difference between treatment collections in complete pain relief at 30 or 60 minutes. Additional "rescue" analgesia was necessityed more often in patients randomized to opiates (254 versus 189 percent; P = 007; number exigencyed to treat, 15). Vomiting was more for the use of all in patients randomized to opiates (195 versus 58 percent; P < 00001; number distressed to harm, seven). Meperidine caused more vomiting than other opiates; there was no difference in the risk of vomiting between other opiates and NSAIDs.

The Institute for Clinical bodys Improvement's guideline on acute pain management proposes that NSAIDS are often adequate for mild or moderate pain.1 It commends that opioids be added to pain therapy in these patients solitary if pain is not controll adequately with NSAIDs alone.

REFERENCE

(1) Institute for Clinical arrangements Improvement (ICSI). Assessment and management of acute pain. Accessed online September 24 2004 at: http://www.icsi.org/knowledge/detail.asp?catID=29&itemID=152.

MARK H EBELL, MD M Holdgate A, Pollock T Nonsteroidal anti-inflammatory mix with drugss (NSAIDs) versus opioids for acute renal colic. Cochrane Database Syst Rev 2004;(3):CD004137

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