Nonsteroidal anti-inflammatory drugs (NSAIDS) versus opioids for acute renal colic

Pollock, Tamara

doi:10.1002/14651858.cd004137.pub3

Cited by 94 publications

(80 citation statements)

References 55 publications

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“…Acute renal colic or nephrolithiasis occurs when mineral or organic solids pass though the upper urinary tract and obstruct the urinary flow (1). It is a common, often recurrent condition with an annual incidence of 1-2 cases per 1000 and a lifetime risk that is greater in men than women (between 10-20% and 3-5%, respectively) (2).…”

Section: Introductionmentioning

confidence: 99%

“…It is a common, often recurrent condition with an annual incidence of 1-2 cases per 1000 and a lifetime risk that is greater in men than women (between 10-20% and 3-5%, respectively) (2). Patients usually present with a sudden onset of severe urinary pain that radiates from the flank to the groin and requires immediate treatment (within 30 minutes of the onset of symptoms) (1). In addition to severe pain, the main signs and symptoms of renal colic include nausea, vomiting, hypertension, swollen abdomen, fever and chills and hematuria.…”

Section: Introductionmentioning

confidence: 99%

“…Pain relief often takes the form of a nonselective, nonsteroidal anti-inflammatory drug (nsN-SAID) or an opioid (1). Nonselective NSAIDs such as ketoprofen reduce pain and inflammation by inhibiting the cyclooxygenase (COX) enzyme (3).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of parecoxib in the treatment of acute renal colic: a randomized clinical trial

Glina¹,

Damião²,

Afif-Abdo³

et al. 2011

Int. braz j urol.

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Purpose: Although nonselective nonsteroidal anti-inflammatory drugs (nsNSAIDs) and opioids are effective treatments for acute renal colic, they are associated with adverse events (AEs). As cyclooxygenase-2 selective NSAIDs may provide a safer alternative, we compared the efficacy and safety of parecoxib versus an nsNSAID in subjects with acute renal colic. Materials and Methods: Phase i.v., multicenter, double-blind, noninferiority, active-controlled study: 338 subjects with acute renal colic were randomized to parecoxib 40 mg i.v. plus placebo (n = 174) or ketoprofen 100 mg i.v. plus placebo (n = 164). 338 subjects with acute renal colic were randomized to parecoxib 40 mg i.v. (n = 174) or ketoprofen 100 mg i.v. (n = 164) plus placebo. Subjects were evaluated 15, 30, 45, 60, 90 and 120 minutes after treatment start and 24 hours after discharge. Primary endpoint was the mean pain intensity difference (PID) at 30 minutes by visual analog scale (VAS) (per-protocol population). An ANCOVA model was used with treatment group, country, and baseline score as covariates. Noninferiority of parecoxib to ketoprofen was declared if the lower bound of the 95% confidence interval (CI) for the difference between the two groups excluded the pre-established margin of 10 mm for the primary endpoint. Results: Baseline demographics were similar. The mean (SD) mPID30 min was 33.84 (24.61) and 35.16 (26.01) for parecoxib and ketoprofen, respectively. For treatment difference (parecoxib-ketoprofen) the lower bound of the 95% CI was 6.53. The mean change from baseline in VAS 30 minutes after study medication was ~43 mm; AEs were comparable between treatments.Conclusions: Parecoxib is as effective as ketoprofen in the treatment of pain due to acute renal colic, is well tolerated and has a comparable safety profile.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of parecoxib in the treatment of acute renal colic: a randomized clinical trial

Glina¹,

Damião²,

Afif-Abdo³

et al. 2011

Int. braz j urol.

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“…Th e same reviewer assessed the full text articles and determined that 14 of the 26 off ered quantitative results that could be analyzed using the GRADE-pro software [28][29][30][31][32][33][34][35][36][37][38][39][40][41]. Th e remaining 12 articles were excluded because they did not compare both drugs assessed in a PICO question [42][43][44][45][46][47], compared analgesics not addressed in the seven P ICO qu estions (such as acetaminophen alone) [48,49], used unconventional medication dosing [50,51], used non-validated pain me asurement scales [52,53], and/or unusual study designs [50].…”

Section: Resultsmentioning

confidence: 99%

Analgesia in the Emergency Department: A GRADE-based Evaluation of Research Evidence and Recommendations for Practice

Lipp

Dhaliwal

Lang

2013

Annual Update in Intensive Care and Emergency Medicine 2013

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Emergency physicians care for patients with pain on an extremely frequent basis [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Th e prevalence of pain as the presenting complaint of patients seeking eme rgen cy department (ED) care ranges from 38 % [3] to as high as 78 % [1]. As a result, evidence-based use of analgesics should be a foundational skill of emergency physicians. However, the literature consistently reports that emergency physicians are ofte n poor at treating pain [1,2,8,13,14,16,19,20] . Notwithstanding the prevalence of pain in the ED, many patients often report that their pain was no t pr oper ly t reated [3,7,20]. I n addi tion to a compromised patient experience, sub-optimal treatment of pain will result in decreased department fl ow, increased wait times, more return visits to the ED, and increased hospitalization rates.Very few evidence-based resources and guideli nes exis t to inform emergency physicians on how to treat pain. One recent guideline on acute pain management compiled by the college of Anaesthetists of Australia and New Zealand [21] was focused primarily on treating pain perioperatively and did not include stratifi ed or graded recommendations based on the literature, highlighting the paucity of emergency medicine-specifi c guidance. Emergency physicia ns need an eff ective, evidenced-based approach to analyze and apply the options available for acute pain management.Th e objective of this article is to synthesize and evaluate the quality of medical literature surrounding analgesia delivery in the adult ED using the Grading Assessment, Development and Evaluation (GRADE) framework. We further strived to provide emergency physicians with graded recommendations upon which analgesics should be used to treat adults with acute pain in the ED. Question formulationPrior to searching the literature we developed seven clinically-oriented questions based on a scoping of the literature and a review of locally utilized ED analgesic order sets. Th is initial surveying of medical literature and our local practice environment allowed us to identify the most commonly prescribed intravenous and oral analgesics used in adult EDs in our health care region.We then used the patient-intervention-comparisonoutcome (PICO) approach to develop our seven research questions (Table 1). Th is approach has been adopted by many authors of systematic reviews and guideline panels, including the Internati onal Liaison Committee on Resuscitation (ILCOR) and the American College of Chest Physicians (ACCP) [22][23][24]. It involves identifying a specifi c population or setting to which recommen dations may be applied. Subseq uently each question compares two specifi c management strategies (intervention and comparison). Fi nally, we defi ned important patient oriented outcomes (e. g., change in pain) as well as any adverse eff ects of the medication or other safety concerns.All seven draft questions were reviewed and revised through an iterative process involving all authors. Th ese seven cl...

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“…In some conditions where prostaglandins play a significant role, such as renal colic, the NSAIDs can be as efficacious as opioids but with a lower incidence of side-effects. 3 Where feasible, sustained-release preparations should be used on a regular basis to keep pain under control; this results in more stable plasma concentrations of the drug, permitting the patient to function in a more normal manner, rather than wondering when they should take their next dose of medication. The steady plasma levels of opioids in particular help to reduce habit-forming behaviour, since there is no 'kick' after each dose or a rapid withdrawal effect resulting in the sudden need for another dose.…”

Section: Principles Of Prescribingmentioning

confidence: 99%

Current treatment options in the management of severe pain

Campbell¹

2010

Prescriber

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Nonsteroidal anti-inflammatory drugs (NSAIDS) versus opioids for acute renal colic

Cited by 94 publications

References 55 publications

Efficacy and safety of parecoxib in the treatment of acute renal colic: a randomized clinical trial

Efficacy and safety of parecoxib in the treatment of acute renal colic: a randomized clinical trial

Analgesia in the Emergency Department: A GRADE-based Evaluation of Research Evidence and Recommendations for Practice

Current treatment options in the management of severe pain

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