The following is a summary of “Comparison of acetaminophen, ketamine, or ketorolac versus morphine in the treatment of acute renal colic: A network meta-analysis,” published in the November 2023 issue of Emergency Medicine by Alghamdi, et al.

Renal colic, caused by urinary tract obstruction due to a calculus, induces intense pain along with associated symptoms like hematuria, nausea, and vomiting. For a network meta-analysis, researchers sought to compare the effectiveness and safety of various analgesic agents in treating acute renal colic.

The study conducted searches in Medline, Embase, and CENTRAL databases for randomized controlled trials (RCTs) comparing different analgesic agents for acute renal colic. Selected medications included intravenous acetaminophen, ketamine, ketorolac, and morphine. The evaluation criteria included pain scores on the visual analog scale (VAS) at 15, 30, and 60 minutes, adverse events, and the need for rescue therapy. A frequentist network meta-analysis was performed using the Netmeta statistical package in R software, ranking treatments with P-scores.

Twelve eligible RCTs were identified. Acetaminophen was ranked as the most effective in reducing pain score at 15 minutes (P-score = 0.74). Ketorolac was deemed the most effective at 30 and 60 minutes (P-score = 0.84 and 0.99, respectively), while morphine ranked the least effective (P-score = 0.07). Morphine exhibited the highest odds of adverse events (P-score = 0.89) and was the most frequently required for rescue therapy (P-score = 0.96) in cases of suboptimal pain relief.

Ketorolac and acetaminophen emerged as the most effective analgesic agents based on pain scores. At the same time, morphine displayed a higher adverse event profile and increased need for rescue therapy in the management of acute renal colic.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723004473