Clinical Question

Does adding dexamethasone to ketorolac improve pain relief in adults with renal colic?

Bottom Line

In a first-of-its-kind study in a single emergency department, adding dexamethasone to ketorolac was more effective than ketorolac monotherapy in decreasing pain in people with renal colic. The effect was seen in the first 30 minutes, but it is likely effective for 60 minutes. (Level of Evidence = 1b)

Synopsis

The study took place in a single emergency department in Iran. The researchers enrolled adults with acute renal colic whose pain intensity was greater than 5 on a visual analog scale of 1 to 10. The participants' stones were confirmed by laboratory and radiographic findings. The researchers randomized the participants to receive a single dose of intravenous ketorolac, 30 mg, plus placebo (n = 60), or ketorolac, 30 mg, plus dexamethasone, 8 mg (n = 60). On average, the age of participants was mid-30s, and they were in severe pain (median score of 9.5). After 30 minutes, both groups of participants achieved meaningful reductions in pain scores, and those receiving dexamethasone had greater reductions than those receiving placebo (−5 vs. −3). However, after an hour, the differences were no longer statistically significant (−7 vs. −5; P = .068). The latter difference is clinically meaningful and suggests the study was too small. During the hour after initial treatment, 21 patients (35%) who received dexamethasone and 35 patients (58%) who received placebo also received a narcotic (number needed to treat = 5; 95% CI, 3 to 19). Many people with renal colic experience nausea. The participants who received dexamethasone were less likely to receive an antiemetic during the hour after initial treatment (12% vs. 28%; number needed to treat = 6; 95% CI, 4 to 44). Although this appears to be the first study published on using dexamethasone in people with renal colic, the authors point out its effectiveness as an adjunct for painful musculoskeletal conditions. This single-site study is too small to detect uncommon harms associated with corticosteroid use.