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Intramuscular piroxicam or intramuscular diclofenac for renal colic
  1. Russell Boyd, Consultant in Emergency Medicine,
  2. Polly Terry, Specialist Registrar in Emergency Medicine
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
  1. Correspondence to: Kevin Mackway-Jones, Consultant (kevin.mackway-jones{at}man.ac.uk)

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Report by Russell Boyd, Consultant in Emergency Medicine Checked by Polly Terry, Specialist Registrar in Emergency Medicine

Clinical scenario

A 35 year old man presents to the emergency department with acute renal colic proven on urine dipstick analysis and urgent IVU. His pain is severe and you would like to give him IM diclofenac as he is vomiting and it is your current practice. He tells you he developed a sterile abscess last time he was given IM diclofenac. You wonder if an alternative NSAID, piroxicam, given by the IM route would be as effective as the diclofenac you are reluctant to give.

Three part question

[In renal colic] is [IM piroxicam or IM diclofenac] better [at reducing pain]?

Search strategy

Medline 1966–08/01 using the OVID interface. [exp piroxicam/ OR piroxicam.mp OR feldene.mp] AND [exp diclofenac/ OR diclofenac.mp OR voltarol.mp] AND [exp kidney calculi/ OR exp Ureteral calculi/ OR renal colic.mp]

Search outcome

Two papers were identified of which one was relevant (table 2).

Table 2

Comment(s)

Both forms of IM NSAID work well with some small advantage in favour of piroxicam in terms of pain relief at 30 minutes. IM voltarol has several notable administration problems that piroxicam does not.

Clinical bottom line

IM piroxicam appears to perform better than IM diclofenac for renal colic pain relief. Given it has fewer injection site side effects IM piroxicam should replace IM diclofenac for renal colic.

Report by Russell Boyd, Consultant in Emergency Medicine Checked by Polly Terry, Specialist Registrar in Emergency Medicine

References

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