Objective
To evaluate the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) compared with placebo or analgesic agents in the treatment of acute renal colic.
Data Sources
The MEDLINE and EMBASE databases were searched using the following terms: anti-inflammatory agent, colic, kidney diseases, and ureteral diseases. The Family Medicine Library Index, references of retrieved articles, and documention centers of pharmaceutical companies were also consulted.
Study Selection
Among 60 retrieved articles, 19 were selected by consensus of a group of four physicians, based on the following criteria: randomized controlled trials, NSAID compared with placebo or analgesic agent in the treatment of acute renal colic, and articles written in either French or English.
Data Extraction
Independent data extraction by four evaluators using a 20-item checklist. Final assessment was by group consensus.
Data Synthesis
The 19 articles presented 20 studies, most comparing parenteral diclofenac or indomethacin (18 of 20) with placebo (n=4) or analgesic agents (n=16), most of which were narcotic agents. The results of pain relief 20 to 30 minutes after drug administration were pooled using the Mantel-Haenszel method for three distinct groups of studies: (1) NSAIDs vs placebo (n=4): relative risk (RR), 2.34 (95% confidence interval [CI], 1.79 to 3.07); (2) NSAIDs vs analgesic agents, partial pain relief (n=9): RR, 1.07 (95% CI, 1.02 to 1.12); and (3) NSAIDs vs analgesic agents, complete pain relief (n=9): RR, 1.19 (95% CI, 1.03 to 1.37).
Conclusions
Parenteral NSAIDs are more effective than placebo and as effective as analgesic agents in the treatment of acute renal colic.
(Arch Intern Med. 1994;154:1381-1387)
