Non-Narcotic Drug Superior for Emergency Renal Colic Management

10.06.2018

Ketorolac is more effective than narcotics in the management of renal colic in the emergency department (ED), yet narcotics remain a common the first-line treatment, according to study findings presented at the American Urological Association 2018 annual meeting.

Traditionally, renal colic, or stone pain, has been controlled by narcotics in the ED, as there were no good alternatives until the development of ketorolac in the early 1990s. Research has repeatedly shown ketorolac to be more effective than opioids for both pain management and avoiding opioid-related side effects, such as nausea and disorientation. Yet, the new study, which assessed treatment patterns of ED physicians in a major US metropolitan hospital, showed that traditional narcotic-based treatment persisted.

Have been considered 1335 ED patients treated for renal colic. Initial medical management consisted of ketorolac alone in 383 patients (29%), opioid alone in 530 patients (40%), and ketorolac and opioid in 423 patients (32%). Ketorolac was more effective than opioids even after accounting for variations in patient-reported initial pain scores and other patient- and stone-related factors. Ketorolac treatment was associated with a shorter length of stay and quicker discharge rate compared with opioid treatment, the investigators reported in a poster presentation. Compared with patients treated with ketorolac only, those treated with opioid only had significant 2-fold increased odds of an ED length of stay more than 3 hours. The investigators observed no significant difference in the odds of an ED length of stay more than 3 hours between patients treated with both ketorolac and an opioid and those treated with ketorolac alone.

Further, patients treated with an opioid alone and ketorolac plus an opioid had significant 4-fold and 2-fold increased odds of hospital admission, respectively, compared with those treated with ketorolac alone. Ketorolac monotherapy was associated with lower use of rescue medications and anti-nausea medications.

Clinicians are advised to allow enough time for the ketorolac to have an effect-typically 30-45 minutes-before reaching for second-line medications.

Reference

Portis AJ, Jain NN, Portis JG, et al. Non-narcotic emergency management of renal colic improves length of stay and discharge rate. Data presented in poster format at the American Urological Association 2018 annual meeting in San Francisco, May 18-21.