NSAIDs best for renal colic

Nonsteroidal anti-inflammatory drugs (NSAIDs) are more effective and safer than paracetamol and opioids for acute renal colic due to kidney stones, according to a large meta-analysis in European Urology (https://doi.org/10.1016/j.eururo.2017.11.001).

Current guidelines recommend NSAIDs but the fear of adverse effects and a uncertainty over efficacy means that many patients are given intravenous opioids.

Data was examined from 468 studies involving 4887 patients. NSAIDs were equivalent to opioids or paracetamol for the relief of acute renal colic pain at 30 minutes. There was less vomiting and fewer requirements for rescue analgesia with NSAIDs compared with opioids. Patients treated with NSAIDs required less rescue analgesia compared with paracetamol. According to the study authors, the findings of a lower need for rescue analgesia and fewer adverse events, in conjunction with the practical advantages of ease of delivery, suggest that NSAIDs should be the preferred analgesic option for patients presenting with renal colic.

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