Analgesia

Traditionally opioids and non steroidal anti-inflammatory drugs (NSAIDS) have been used in renal colic and both appear to be effective. A Cochrane database review in 2005 analysed 29 trials with a total of over 1,600 participants and although heterogeneity limited pooling of results, and the predominant opiate was pethidine, several conclusions could be drawn [5]:

• Rescue medication requirements are less with NSAIDS
• Lower pain scores are reported with NSAIDS
• Higher rates of adverse effects are seen with opiates
• Ureteric inflammation may be reduced in NSAIDS administration facilitating stone passage

Learning bite

Offer an NSAID by any route as first-line treatment for adults, children and young people with suspected renal colic. If contraindicated then offer intravenous paracetamol to adults, children and young people with suspected renal colic or if NSAIDs are not giving sufficient pain relief. Consider opioids if rescue medication required.