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Best evidence topic reports
Rectal or intravenous non-steroidal anti-inflammatory drugs in acute renal colic
  1. Caroline Lee, Specialist Registrar,
  2. Dhurga Gnanasegaram,
  3. Margaret Maloba, Specialist Registrars
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; s.carley1btinternet.com

    Abstract

    A short cut review was carried out to establish whether rectal non-steroidal anti-inflammatory drugs (NSAIDs) are as effective as IV NSAIDs in the management of acute renal colic. Altogether 179 papers were found using the reported search, of which two represent the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. Rectal NSAIDs are an effective form of analgesia for patients with acute renal colic and have fewer side effects compared with intravenous NSAIDs.

    • NSAIDs
    • renal colic

    https://doi.org/10.1136/emj.2005.028654

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      Report by Caroline Lee, Specialist Registrar 
 Checked by Dhurga Gnanasegaram and Margaret Maloba, Specialist Registrars

      Three part question

      In [patients with a clinical diagnosis of renal colic] is [PR NSAIDs better than IM NSAIDs] at [reducing pain (length and speed of analgesia)]?

      Clinical scenario

      A 21 year old male presents to the emergency department with sudden onset of left lumbar pain radiating to the groin. A clinical diagnosis of renal colic is made. You wonder whether rectal NSAIDs would be more effective than IV or IM NSAIDs?

      Search strategy

      Medline 1966–03/2005 using the OVID interface. [Exp Urinary Calculi OR exp Kidney Calculi OR renal colic.mp OR ureteric colic.mp OR renal calculi.mp OR kidney stone.mp] AND [exp Anti-Inflammatory Agents, Non Steroidal OR NSAID.mp] LIMIT to humans and English language. The Cochrane Library of systematic reviews Issue 1 2005: “renal colic OR NSAID”.

      Search outcome

      A total of 179 papers were found of which two were relevant to the question. No additionally relevant citations were found in The Cochrane Library.

      Comment(s)

      There are many studies in the literature which compare intravenous with intramuscular NSAID use in acute renal colic. Unfortunately no studies were found comparing intramuscular NSAIDs with rectal NSAIDs, which are commonly used in our emergency departments. Rectal NSAIDs have advantages in busy departments by providing urgent analgesia when there are delays in staff available to cannulate the patient and the patient is vomiting.

      CLINICAL BOTTOM LINE

      Rectal NSAIDs are an effective form of analgesia for patients with acute renal colic and have fewer side effects compared with intravenous NSAIDs.

      View this table:
      Table 1

      Report by Caroline Lee, Specialist Registrar 
 Checked by Dhurga Gnanasegaram and Margaret Maloba, Specialist Registrars

      References

      1. ↵
        Nelson CE, Nylander C, Olsson AM. et al. Rectal v. intravenous administration of indomethacin in the treatment of renal colic. Acta Chir Scand1988;154:253–5.
        OpenUrlPubMedWeb of Science
      2. ↵
        Nissen I, Birke H, Olsen JB. et al. Treatment of ureteric colic. Intravenous versus rectal administration of indomethacin. Br J Urol1990;65:576–9.
        OpenUrlCrossRefPubMedWeb of Science