EFFICACY OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS IN THE TREATMENT OF ACUTE RENAL COLIC - A METAANALYSIS

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.