Comparison of Acetaminophen, Ketamine, or Ketorolac versus Morphine in the Treatment of Acute Renal Colic: A Network Meta-Analysis
Authors: Yasir A Alghamdi, Roaa E Morya, Dena M Bahathiq, Abdullah F Bokhari, Ahmad K Alaboud, Ahmed S Abdulhamid, Abdullah A Ghaddaf, Maan Jamjoom
Journal: American Journal of Emergency Medicine, August 20, 2023
Conclusion:
- Ketorolac and acetaminophen are the most effective analgesic agents for acute renal colic based on pain scores.
- Morphine has the highest adverse event profile and the highest necessity for rescue therapy.
Results:
- 12 RCTs were included.
- Acetaminophen was the most effective in reducing pain score at 15 min (P-score = 0.74).
- Ketorolac was the most effective at 30 and 60 min (P-score = 0.84 and 0.99 respectively).
- Morphine was the least effective (P-score = 0.07) and was associated with the highest odds of adverse events (P-score = 0.89) and the highest rate of rescue therapy requirement (P-score = 0.96).
Methods:
- Data Sources: Medline, Embase, CENTRAL databases.
- Inclusion: Randomized controlled trials (RCTs) comparing different analgesic agents.
- Analgesic Agents: Intravenous acetaminophen, ketamine, ketorolac, and morphine.
- Outcomes: Pain score on the visual analog scale (VAS) at 15, 30, and 60 min; adverse events; utilization of rescue therapy.
- Analysis: Frequentist network meta-analysis using Netmeta package in R software.
- Ranking: Netrank function yielding P-scores.
Alghamdi, Y.A., Morya, R.E., Bahathiq, D.M., Bokhari, A.F., Alaboud, A.K., Abdulhamid, A.S., Ghaddaf, A.A. and Jamjoom, M., 2023. Comparison of acetaminophen, ketamine, or ketorolac versus morphine in the treatment of acute renal colic: A network meta-analysis. The American Journal of Emergency Medicine.