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2108 Metoclopramide for analgesia in renal colic – a systematic review
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  1. Andrew Tabner1,
  2. Graham Johnson1,
  3. Nicholas Tilbury1,
  4. Matthew Reed2,
  5. Suzanne Toft1,
  6. Apostolos Fakis1,
  7. Adithan Ganesh3,
  8. Nikhil Ponna3,
  9. Lucy Hobbs3
  1. 1University Hospitals of Derby and Burton NHS Foundation Trust
  2. 2Edinburgh Royal Infirmary
  3. 3University of Nottingham

Abstract

Aims and Objectives Renal colic is often extremely painful, and existing analgesic regimes frequently provide insufficient relief. There is biological plausibility that metoclopramide, a prokinetic antiemetic with activity at multiple receptor types, may be a useful treatment for renal colic pain. This review identifies and evaluates the relevant evidence concerning its use for this indication.

Objective To systematically evaluate the existing evidence for whether metoclopramide is an effective analgesic in the management of adults with renal colic.

Method and Design Evidence Acquisition: The following databases were searched in November 2022: CENTRAL; MEDLINE; EMBASE; AMED; MIDIRS; HMIC; Global Health Archive on Trial; Google Scholar; PROSPERO. Reference lists of eligible articles were hand-searched.

Study eligibility: Randomised, quasi-randomised or baseline-matched case-control clinical trials evaluating metoclopramide for analgesia in patients with renal colic, reporting pain as an outcome assessed using any recognised measure of pain severity.

Review process: Titles and abstracts were screened by two authors independently; disagreement was resolved by discussion or by adjudication by a third author. Full text review was performed by two authors independently, with disagreements resolved as above.

Assessment of bias: The Cochrane Collaboration Risk of Bias Tool v2.0 was used to assess bias.

Results and Conclusion Evidence Synthesis: Two studies were included. Heterogeneity of primary outcome measurement and comparators rendered meta-analysis inappropriate; a narrative review is presented. Both studies showed evidence of analgesic effect; each demonstrated equivalence with alternative analgesic options (tenoxicam and Spasmofen), the latter being a combination analgesic no longer in routine use in clinical practice.

Conclusions There is some evidence that metoclopramide may be an effective analgesic in the management of renal colic, with the highest quality study demonstrating analgesic properties similar to an intravenous non-steroidal anti-inflammatory medication. Existing evidence is insufficient to recommend adoption of metoclopramide within the analgesic regime for renal colic as part of standard care.

Abstract 2108 Figure 1

A PRISMA flow diagram of evidence acquisition in a systematic review of the analgesic properties of metoclopramide for the pain of renal colic

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