ORAL INDOMETHACIN FOR ACUTE RENAL COLIC

A number of studies have suggested that nonsteroidal antiinflammatory agents can relleve ranal colic by a mechanism of action different from that of narcotics, offaring the potential advantage of avoiding narcotic side-effects such as alteration of mental status. The authors prospectively administered oral indomethacin, 50 mg, to 25 nonvomiting patients with acute renal colic due to a documented stone. Eleven patients group (I) received the drug in an unblinded, nonrandomized fashion after failure of oral or parenteral narcotics to provide satisfactory pain relief, either at home or in the emergency department. In 14 additional patients group (II) indomethacin was given as the only initial treatment. Pain intensity before and after treatment was reported using a 1-to-10 scale. In group I, pain decreased from 5.8 ± 2.7 to 3.6 ± 3.8 (P < .02). Six of the 11 patients reported a decrease in pain intensity of 50% or more, which occurred within 25 ± 11 minutes, and in 5 of these 6, pain decreased to a 0 or 1 level. In group II, pain decreased from 7.6 ± 1.5 to 4.6 ± 4.0 (P < .008). Eight of the 14 patients reported a decrease in pain intensity of 50% or more, which occurred within 40 ± 14 minutes, and in 5 of these 8 pain decreased to a 0 or 1 level. Among all 25 patients who received indomethacin, pain reliel was not significantly associated with the duration of pain before trestment or with patient age or sex. There was a trend for pretreatment pain intensity to be higher among nonresponders (P = .07). Vomiting occurred in 1 individual after receiving indomethacin; no other significant side effects were reported. Patients who responded to indomethacin were discharged on oral indomethacin. All were able to continue with dally activities; only one had returned for further pain control at 1 week follow up. Two patients successfully treated further episodes of renal colic at home with oral indomethacin. The authors conclude that placebo-controlled studies are warranted to define the appro-priate role for indomethacin and similar agents in the management of acute renal colic. © 1991.