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In individuals battling with acute renal colic, Ketorolac and Acetaminophen are the most efficient pain relievers.
According to a network meta-analysis, Ketorolac demonstrated the highest efficacy in ameliorating pain scores at 30 and 60 minutes, while Acetaminophen proved most efficient at the 15-minute mark for management of acute renal colic. The objective of the researchers was to assess and compare the effectiveness and safety of Acetaminophen, Ketamine, Ketorolac, and Morphine in acute renal colic.
For relevant literature search, databases like CENTRAL, Medline, and Embase were explored. They included randomized controlled trials (RCTs) that compared various analgesic agents, whether used individually or in combination, for acute renal colic. The selection of these analgesic agents was based on established medical practices and encompassed intravenous Acetaminophen, Ketamine, Ketorolac, and Morphine.
Assessment of pain levels was done on visual analog scale (VAS) at 15, 30, and 60 minutes, as well as to examine need for rescue treatment, and adverse events. To evaluate the efficiency of various analgesics, a frequentist network meta-analysis was conducted utilizing Netmeta statistical package in R software. Ranking of the treatments was done with the utilization of the Netrank function, which generated P-scores.
In the analysis of 12 eligible RCTs, Acetaminophen emerged as most efficient in decreasing pain scores at the 15-minute mark with a P-score of 0.74. At both the 30-minute and 60-minute intervals, Ketorolac demonstrated the highest effectiveness with P-scores of 0.84 and 0.99, respectively.
In contrast, Morphine was found to be the least effective, registering a low P-score of 0.07. Additionally, Morphine was associated with the highest likelihood of causing adverse events after treatment, as indicated by a P-score of 0.89.
Moreover, in cases where pain relief was suboptimal, Morphine was the most frequently administered rescue therapy, with a P-score of 0.96. Based on pain scores, Ketorolac and Acetaminophen proved to be the most efficient analgesic agents, while Morphine exhibited the highest occurrence of adverse events and the greatest need for rescue therapy in the treatment of acute renal colic.
The American Journal of Emergency Medicine
Comparison of Acetaminophen, Ketamine, or Ketorolac versus Morphine in the treatment of acute renal colic: A network meta-analysis
Yasir A. Alghamdi et al.
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