Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-22T20:44:01.126Z Has data issue: false hasContentIssue false
  • English
  • Français

The NARC (Nonsteroidal Anti-inflammatory in Renal Colic) Trial. Single-dose intravenous ketorolac versus titrated intravenous meperidine in acute renal colic: a randomized clinical trial

Published online by Cambridge University Press:  21 May 2015

Victor M. Wood ,
James M. Christenson ,
Grant D. Innes ,
Mary Lesperance  and
R. Douglas McKnight
Victor M. Wood*
Affiliation:
the Department of Surgery, University of British Columbia, Vancouver, BC Royal Jubilee Hospital, Victoria, BC
James M. Christenson
Affiliation:
the Department of Surgery, University of British Columbia, Vancouver, BC St. Paul’s Hospital, Vancouver
Grant D. Innes
Affiliation:
the Department of Surgery, University of British Columbia, Vancouver, BC St. Paul’s Hospital, Vancouver Royal Columbian Hospital, New Westminster, BC
Mary Lesperance
Affiliation:
the Department of Mathematics and Statistics, University of Victoria, Victoria
R. Douglas McKnight
Affiliation:
the Department of Surgery, University of British Columbia, Vancouver, BC Vancouver Hospital, Vancouver
*
Department of Emergency Medicine, Royal Jubilee Hospital, 1900 Fort St., Victoria BC V8R 1J8; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives:

Intravenous (IV) opioid titration is an accepted method of relieving acute renal colic. Studies have shown that nonsteroidal anti-inflammatory drugs (NSAIDs) are also effective in this setting. Our objective was to compare single-dose ketorolac and titrated meperidine, both administered intravenously, with respect to speed and degree of analgesia, adverse effects and functional status. Our primary hypothesis was that these agents provide equivalent analgesia within 60 minutes. Our secondary hypotheses were that ketorolac-treated patients would experience fewer adverse effects and would be better able to resume usual activity.

Methods:

This was a multicentre, double-blind randomized equivalence trial in a convenience sample of patients age 18–65 with moderate or severe renal colic, documented by intravenous pyelogram, ultrasound or stone passage. Meperidine-treated patients received 50 mg IV meperidine at 0 minutes, then 25–50 mg every 15 minutes as needed for ongoing pain. Ketorolac-treated patients received 30 mg IV ketorolac at 0 minutes and placebo injections every 15 minutes as needed. Pain levels and adverse effects were assessed every 15 minutes, and functional status was evaluated at 60 minutes. Our primary outcome was the proportion of patients with mild or no pain at 60 minutes.

Results:

Overall, 49 of 77 meperidine-treated patients (64%; 95% confidence interval [CI], 53%–75%) and 47 of 65 ketorolac-treated patients (72%; 95% CI, 61%–83%) achieved successful pain relief at 60 minutes (p value for equivalence = 0.002). Ten percent of meperidine-treated patients and 44% of ketorolac-treated patients were able to resume usual activity at 60 minutes (p = 0.001).

Conclusions:

In the doses studied, single-dose IV ketorolac is as effective as titrated IV meperidine for the relief of acute renal colic and causes less functional impairment.

Keywords

renal colicketorolacmeperidineanti-inflammatory agentsnonsteroidal
Type
Em Advances • Progrès de la Mu
Information
Canadian Journal of Emergency Medicine , Volume 2 , Issue 2 , April 2000 , pp. 83 - 89
Copyright
Copyright © Canadian Association of Emergency Physicians 2000

References

1.Rosen, P, Barkin, R, Danzl, D, editors. Emergency medicine, concepts and clinical practice, 4th ed. St. Louis: Mosby Year-Book; 1998. p. 282.Google Scholar
2.Rosen, P, Barkin, R, Danzl, D, editors. mergency medicine, concepts and clinical practice, 4th ed. St. Louis: Mosby Year-Book 1998. p. 279.Google Scholar
3.Lundstam, S, Wahjander, L, Kral, JG. Treatment of ureteral colic by prostaglandin synthetase inhibition with diclofenac sodium. Cur Ther Res 1980;28:355–8.Google Scholar
4.Lundstam, S, Wahjander, L, Kral, JG, Leissner, K.Prostaglandin synthetase inhibition with diclofenac sodium in treatment of renal colic: comparison with use of a narcotic analgesic. Lancet 1982;1:1096–7.Google Scholar
5.Vignoni, A, Fierro, A, Moreschini, G, Cau, M, Agostino, A, Daniele, E, et al. Diclofenac sodium in ureteral colic: a double blind comparison trial with placebo. J Int Med Res 1983;11:303–7.Google Scholar
6.Grenabo, L, Aurell, M, Delin, K, Holmlund, D, Sjodin, JG. Antidiuretic hormone levels and the effect of indomethacin on ureteric colic. J Urology 1983;129:941–3.Google Scholar
7.Sommer, P, Kromann-Andersen, , Lendorf, A, Lyngdorf, P, Moller, P.Analgesic effect and tolerance of Voltaren and Ketogan in acute renal or ureteric colic. Br J Urol 1989;63:4–6.Google Scholar
8.Wolfson, AB, Yealy, DM.Oral indomethacin for acute renal colic. Am J Emerg Med 1991;9:16–9.Google Scholar
9.Thompson, JF, Pike, JM, Chumas, PD, Rundle, JSH. Rectal diclofenac compared with pethidine injection in acute renal colic. Br Med J 1989;299:1140–1.Google Scholar
10.Larsen, LS, Miller, A, Allegra, JR.The use of intravenous ketorolac for the treatment of renal colic in the emergency department. Am J Emerg Med 1993;11:197–9.Google Scholar
11.Cordell, WH, Wright, SW, Wolfson, AB, Timerding, BL, Maneatis, TJ, Lewis, RH, et al. Comparison of intravenous ketorolac, meperidine, and both (balanced analgesia) for renal colic. Ann Emerg Med 1996;28:151–8.Google Scholar
12.The Subcutaneous Sumatriptan International Study Group. Treatment of migraine attacks with sumatriptan. N Engl J Med 1991;325:316–21.Google Scholar
13.Dunnett, CW, Gent, M.Significance testing to establish equivalence between treatments, with special reference to data in the form of 2×2 tables. Biometrics 1977;33:593–602.Google Scholar
14.The COBALT Investigators. A comparison of continuous infusion of alteplase with double-bolus administration for acute myocardial infarction. N Engl J Med 1997;337:1124–30.Google Scholar
15.Tebbe, U, Michels, R, Adgey, J, Boland, J, Caspi, A, Charbonnier, B, et al. Randomized, double-blind study comparing saruplase with streptokinase therapy in acute myocardial infarction: The COMPASS equivalence trial. J Am Col Card 1998;31:487–93.Google Scholar
16.Ware, JH, Antman, EM.Equivalence trials. N Engl J Med 1997; 337:1159–61.Google Scholar