Parecoxib Vs Paracetamol for Treatment of Acute Renal Colic Due to Ureteric Calculi: A Randomized Controlled Trial

Al‐Terki, Abdullatif; Hussain, Jaffar M.; El-Nahas, Ahmed R.; Aloumi, Abdullatif; Al-Asfoor, Monira; Altamimi, Abbas; Abdelhamid, Usama; Alkabbani, Majd; Al-Shaiji, Tariq F.

doi:10.1016/j.urology.2020.12.017

Cited by 3 publications

(11 citation statements)

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“…In 24 trials,9–14 16–30 36–38 the change in pain scores from T0 to T30 was reported, and all trials except one29 reported that all groups (paracetamol, NSAIDs or opioids) achieved clinically significant reductions in pain scores from T0 to T30. Key data were missing from 25 papers, and the lead authors were contacted to request the information,8–32 but no authors replied to requests for data.…”

Section: Resultsmentioning

confidence: 99%

“…IVP was administered as a single dose of 1 g in 100 mL NS (100 ml normal saline) in 26 trials8–13 15–19 21–30 32 36–38 and at a dose of 15 mg/kg in one trial 20. The infusion rate for the administration of IVP was as a rapid bolus infusion in three trials,11 12 24 slow infusion over 5–20 min in 16 trials,8 10 13 16 18 19 21 22 25 26 29–32 36–38 and not mentioned for 8 trials 9 14 15 17 20 23 27 28. Doses of morphine were 0.1 mg/kg in 12 trials,9 13 19–23 25–28 37 5 mg/mL in 1 trial30 and 10 mg in 2 trials 18 31…”

Section: Resultsmentioning

confidence: 99%

“…Of the 27 studies included in the review, 20 trials8–13 15 17–21 23–28 32 36 were assessed to have a high or unclear risk of bias, and 7 trials14 16 22 29 30 37 38 were assessed to have a low risk of bias using the ROB V.2 tool. The domains assessed as having some concern or a high risk of bias were randomisation process (22 studies), deviation from intended intervention (19 studies), bias due to missing outcome data (17 studies), bias in the measurement of outcome (18 studies) and bias in the selection of reported outcome (17 studies) (risk of bias table, online supplemental appendix 2).…”

Section: Resultsmentioning

confidence: 99%

“…There was a high degree of missing information: 12 trials9 13 15 17 21 23–28 31 did not provide information regarding the intention to treat analysis; 5 trials9–12 24 had missing baseline characteristics; and 5 trials8 14 18 20 29 did not provide information regarding allocation concealment.…”

Section: Resultsmentioning

confidence: 99%

“…After full analysis, 13 trials were excluded (figure 1). Key data were missing from 25 papers, and the lead authors were contacted to request the information 8–32…”

Section: Methodsmentioning

confidence: 99%

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Comparison of intravenous paracetamol (acetaminophen) to intravenously or intramuscularly administered non-steroidal anti-inflammatory drugs (NSAIDs) or opioids for patients presenting with moderate to severe acute pain conditions to the ED: systematic review and meta-analysis

et al. 2023

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ObjectiveParacetamol, non-steroidal anti-inflammatory drugs (NSAIDs) and opiates/opioids, administered parenterally via intravenous or intramuscular route, are widely used to provide analgesia for patients with moderate to severe pain. This systematic review and meta-analysis evaluated the level of analgesia provided by intravenous paracetamol (IVP) alone compared with NSAIDs (intravenous or intramuscular), or opioids (intravenous) alone in adults attending the ED with acute pain.MethodsTwo authors independently searched PubMed (MEDLINE), Web of Science, Embase (OVID), Cochrane Library, SCOPUS and Google Scholar (3 March 2021–20 May 2022) for randomised trials without any language or date restriction. Clinical trials were evaluated using the Risk of Bias V.2 tool. The primary outcome was mean difference (MD) for pain reduction at 30 min (T30) post analgesia delivery. The secondary outcomes were MD in pain reduction at 60, 90 and 120 min; the need for rescue analgesia; and the occurrence of adverse events (AEs).ResultsTwenty-seven trials (5427 patients) were included in the systematic review and 25 trials (5006 patients) in the meta-analysis. There was no significant difference in pain reduction at T30 between the IVP group and opioids (MD −0.13, 95% CI −1.49 to 1.22) or IVP and NSAIDs (MD −0.27, 95% CI −1.0 to 1.54. There was also no difference at 60 min, IVP group versus opioid group (MD −0.09, 95% CI −2.69 to 2.52) or IVP versus NSAIDs (MD 0.51, 95% CI 0.11 to 0.91). The quality of the evidence using Grading of Recommendations, Assessments, Development and Evaluations methodology was low for MD in pain scores.The need for rescue analgesia at T30 was significantly higher in the IVP group compared with the NSAID group (risk ratio (RR): 1.50, 95% CI 1.23 to 1.83), with no difference found between the IVP group and the opioid group (RR: 1.07, 95% CI 0.67 to 1.70). AEs were 50% lower in the IVP group compared with the opioid group (RR: 0.50, 95% CI 0.40 to 0.62), whereas no difference was observed in the IVP group compared with the NSAID group (RR: 1.30, 95% CI 0.78 to 2.15).ConclusionIn patients presenting to the ED with a diverse range of pain conditions, IVP provides similar levels of pain relief compared with opiates/opioids or NSAIDs at T30 post administration. Patients treated with NSAIDs had lower risk of rescue analgesia, and opioids cause more AEs, suggesting NSAIDs as the first-choice analgesia and IVP as a suitable alternative.PROSPERO registration numberCRD42021240099.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…After full analysis, 13 trials were excluded (figure 1). Key data were missing from 25 papers, and the lead authors were contacted to request the information 8–32…”

Section: Methodsmentioning

confidence: 99%

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