Clinical Question

Which agents are most effective in relieving pain in adults with renal colic?

Bottom Line

In the network meta-analysis, acetaminophen and ketorolac were more effective than morphine in alleviating pain from renal colic and were less likely than morphine to cause adverse effects and a need for rescue analgesia. (Level of Evidence = 1a−)

Synopsis

The authors searched databases, a registry, and the reference list of retrieved papers to identify English-language publications of randomized trials that compared intravenous acetaminophen, ketorolac, and ketamine alone or in combination with morphine in adults with renal colic. The primary outcomes were pain scores on a visual analog scale at various time intervals, rescue medication use, and adverse events. The authors included 12 studies with 2,845 adults and 72% were men. Eight of the studies were at low risk of bias. Some of the studies used the combination of an analgesic and morphine. After pooling the data, in addition to studying rescue therapy and adverse events, the authors were able to conduct a network meta-analysis for pain scores at 15, 30, and 60 minutes. At 15 minutes, there was no significant difference in the average pain scores among the treatments. After 30 minutes, patients treated with ketorolac or acetaminophen had modest reductions in pain compared with morphine (−1.6 and −1.0 points on a visual analog scale), and at 60 minutes, only those treated with ketorolac had significant pain reductions (−2.9 points on a visual analog scale). Morphine therapy was most likely to be associated with adverse events and the need for rescue therapy.