INTRODUCTION: Renal colic is an acute syndrome of unilateral flank pain, arising from obstruction of urinary tracts. The challenge for emergency physicians, after ruling-out differential diagnoses and paying attention to potential complications, is finding a suitable pain relief technique. Most common drugs used for renal colic pain relief are parenteral opioids and nonsteroidal anti-in!ammatory drugs (NSAID).
The aim of the study was to assess the possible therapeutic effect of intramuscular 20 mg piroxicam compared with intramuscular 75 mg diclofenac, as a reference drug, on acute renal colic.
METHODS: Randomized, double-blind and controlled clinical trial conducted in emergency department. Inclusion of adult patients admitted to ED with symptoms related to acute renal colic.
Comparison of two randomized groups: patients treated with intramuscular 20 mg piroxicam vs patients treated with intramuscular 75 mg diclofenac.
The primary end-point was the number of patients whom visual analog scale (VAS) at 30 minutes (min) was less than 30 mm. The secondary endpoints were VAS at 30 minutes and need for rescue treatment.
RESULTS: 129 patients were enrolled for 132 non complicated renal colic. Mean age was 37±9 years. Sex ratio was 2.2. Third of patients (n=46) had a past history of renal colic. Microscopic hematuria was noticed by urine test strips in 114 patients (86%). Plain abdominal X-ray was checked in 105 patients (79%). The obstruction was caused by radiopaque kidney stones in 52% of cases. Pain was severe with a mean VAS = 80± 17 mm. Patients were randomized into two groups: “Piroxicam” group (n=67) versus “Diclofenac” group (n=65). The two groups were comparable regarding demographics data, history of renal colic and baseline VAS. "e VAS reduction 30 min after drug administration was signi$cant in the two groups but was higher in the diclofenac group compared to the piroxicam group. The primary endpoint was reached in 35 patients (54%) in diclofenac group versus 23 patients (34%) in piroxicam group (p=0.02). There was no significant differences between the two groups in terms of rescue treatment (need for acetaminophen)l after 30min when VAS ≥ 30 mm). The morphine was more prescribed in piroxicam group (n=6) compared to diclofenac group (n=1).
CONCLUSION: Intramuscular piroxicam can be used successfully when treating pain in acute renal colic but is less effective than intramuscular diclofenac.
Key words: Renal colic, nonsteroidal anti-inflammatory drugs, piroxicam, diclofenac, emergency.