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SOCRATES Episode II (synopsis of Cochrane reviews applicable to emergency services Episode II): the return of Series III
  1. P Gilligan1,
  2. A Pountney2,
  3. B Wilson2,
  4. C Mehigan2,
  5. E Kidney2,
  6. P Jennings2,
  7. J Cooper3,
  8. D Hegarty4,
  9. J Lee5,
  10. A Khan6,
  11. G Lumsden3,
  12. D Godden2,
  13. M Shepherd7,
  14. L Allonby-Neve2,
  15. A Broderick1,
  16. S Carr1,
  17. S Wilson8,
  18. J O’ Sullivan9
  1. 1Beaumont Hospital, Dublin, Ireland
  2. 2The Yorkshire Rotation, Yorkshire, UK
  3. 3St James’s University Hospital, Leeds, Yorkshire, UK
  4. 4Ballymun Health Centre, Ballymun, Dublin, Ireland
  5. 5York Hospital, York, Yorkshire, UK
  6. 6Bradford Royal Infirmary, Bradford, Yorkshire, UK
  7. 7Pinderfield Hospital, Wakefield, Yorkshire, UK
  8. 8Huddersfield District General Hospital, Huddersfield, Yorkshire
  9. 9The Mater Hospital, Dublin, Ireland
  1. Correspondence to:
 Dr P Gilligan
 Beaumont Hospital, Beaumont Road, Dublin D9, Ireland; peadargilligan{at}beaumont.ie

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 To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.
 Sir William Osler (1849–1919)

In this article, the SOCRATES group summarises 12 reviews from the Cochrane Database of Systematic Reviews produced by the Renal Group that we felt were of particular relevance to our colleagues in emergency medicine.

METHODS

The method used to find and summarise the 12 reviews relating to renal medicine and urology is as described previously.

NON-STEROIDAL ANTI-INFLAMMATORY DRUGS VERSUS OPIOIDS FOR ACUTE RENAL COLIC

Renal colic is a very painful and distressing condition. Most renal calculi pass spontaneously. Relief of pain is one of the integral parts of the management of this condition. The use of both non-steroidal anti-inflammatory drugs (NSAIDs) and opioids has been recommended.

Results

The reviewers found 20 trials with 1613 participants. There was a marked heterogeneity between the studies, and as a result all the groups were not pooled. In all, 10 of 13 groups showed reduced incidence of use of rescue medication and reduced side effects with NSAIDs. NSAIDs did not reduce the use of opioid but did reduce pain scores. NSAIDs may have fewer side effects than pethidine. There were more side effects with opioids.

SOCRATES says

Both opioids and NSAIDs can be used in the treatment of renal colic, but opioids are associated with more adverse effects.

Holdgate A, Pollock T. Nonsteroidal anti-inflammatory drugs (NSAIDs) versus opioids for acute renal colic (Cochrane Review) Cochrane library. Cochrane Database Syst Rev 2006;(4); CD004137.

FLUIDS AND DIURETICS FOR ACUTE URETERIC COLIC

Fluids and diuretics have been used to increase renal flow in the hope of enabling the patient to pass calculi more quickly. Evidence to support this treatment regimen was examined.

Results

The reviewers identified one trial with 60 participants. This study compared 3 l of intravenous fluid with no intravenous fluid …

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