What is the best analgesic option for patients presenting with renal colic to the emergency department? Protocol for a systematic review and meta-analysis

Abstract

IntroductionPatients with renal colic present to the emergency department in excruciating pain. There is variability in practice regarding the choice of initial analgesic to be used in renal colic. The aim of this article is to outline the protocol for review of the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs), opioids and paracetamol use in renal colic pain management.Methods and analysisThis is the protocol for a systematic review, comparing efficacy of NSAIDs, opioids and paracetamol in renal colic studied under randomised controlled trial (RCT) design. This protocol reporting is based on the PRISMA-P recommendations (PRISMA-P-checklist). We will conduct a comprehensive literature search for both peer-reviewed and grey literature published until 18 December 2016. Using a predefined search strategy, MEDLINE, Embase and Cochrane Central Register of Controlled Trials will be searched. Additional searches will include WHO International Clinical Trials Registry Platform, abstract list of relevant major conferences and the reference lists of relevant publications. Two authors will independently screen and identify the studies to be included. The RCT comparing NSAIDs versus opioids or paracetamol will be included in the review, if the age of participants in the study was >16 years and they presented with moderate to severe renal colic. Any disagreement between the screening authors will be resolved through discussion and reaching consensus; if not, a third reviewer will arbitrate. Quantitative data from homogeneous studies will be pooled in the meta-analysis using RevMan V.5.3 software. The findings of this review will be presented according to the guidelines in the Cochrane Handbook of Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Review and Meta-Analysis statement.Ethics and disseminationFormal ethics approval is not required, as primary data will not be collected. We plan to publish the result of this review in a peer-reviewed journal.

Intravenous paracetamol versus ketorolac for pain attenuation in patients with renal colic; a randomized, single blind and controlled clinical trial

“…NSAIDs and opioids have been reported to be the main classes of drugs for pain relief in patients with renal colic. However, different side effects have been reported for these drugs (15). Moreover, evidence suggested that frequently use of KET is related to enhanced risk of gastrointestinal bleeding (8).…”

“…Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are commonly used as pain relievers in emergency department. However, both of these classes of drugs have many side effects (6). In a meta-analysis, NSAIDs were found to be as effective as different types of analgesic agents such as narcotics in treatment of acute renal colic (7).…”

An effective treatment option for pain caused by urolithiasis: A randomised‐controlled trial of local active warming with heat‐patch

“…Their use is also limited in patients with hepatic failure and chronic obstructive pulmonary disease 5 . Opioids the other analgesic option have a wide range of side effects, including nausea, vomiting, hypotension, sedation, dizziness, and even respiratory depression 9,10 …”

Epidural analgesia for the treatment of colic attack with retrocaval ureter in late pregnancy complicated with marginal placenta previa: a case report

“…Non-steroidal anti-inflammatory drugs (NSAIDs), or less effective opioids, such as morphine (when NSAIDs [6] are ineffective or contraindicated), are generally prescribed for acute flank pain in urological disease. However, NSAID administration in late pregnancy is associated with severe adverse neonatal outcomes [7].…”