Intramuscular piroxicam is better than Intramuscular diclofenac for renal colic
Date First Published:
November 23, 2000
Last Updated:
November 6, 2001
Report by:
Russell Boyd, Consultant in Emergency Medicine (Manchester Royal Infirmary)
Search checked by:
Polly Terry, Manchester Royal Infirmary
Three-Part Question:
[In renal colic] is [IM piroxicam or IM diclofenac] better [at reducing pain]?
Clinical Scenario:
A 35 year old male presents to A&E with acute renal colic proven on urine dipstick analysis and urgent IVU. His pain is severe and you would like to give him IM diclofenac as he is vomiting and it is your current practice. He tells you he developed a sterile abscess last time he was given IM diclofenac. You wonder if an alternative NSAID, piroxicam, given by the IM route would be as effective as the diclofenac you are reluctant to give.
Search Strategy:
Medline 1966-08/01 using the OVID interface.
Search Details:
[exp piroxicam OR piroxicam.mp OR feldene.mp] AND [exp diclofenac OR diclofenac.mp OR voltarol.mp] AND [exp kidney calculi OR exp Ureteral calculi OR renal colic.mp]
Outcome:
2 papers were identified of which 1 was relevant.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Intramuscular piroxicam versus intramuscular diclofenac sodium in the treatment of acute renal colic: double-blind study. Al-Waili NS and Saloom KY. 1999, Germany | 64 patients with proven diagnosis of renal colic on IVU, USS and clinical examination Those taking NSAIDS or pethidine on long-term basis excluded |
Double blind randomised controlled study | Change in mean pain scores at 30 and 60 minutes post administration of 75mg IM diclofenac or 40mg IM piroxicam as measured on a Visual Analogue 10cm line | Both treatments dramatically decreased pain scores by 30 minutes. Diclofenac pre-treatment score 7.83 and 30 minutes post treatment 1.47; piroxicam pre-treatment score 7.41 with 30 minutes post treatment score 0.84. There was a significant improvement in favour of piroxicam for pain relief at 30 minutes (t-test of means p<0.05) | The blinding mechanism is not given Uncertain of sampling method |
Author Commentary:
Both forms of IM NSAID work well with some small advantage in favour of piroxicam in terms of pain relief at 30 minutes. IM voltarol has several notable administration problems that piroxicam does not.
Bottom Line:
IM piroxicam appears to perform better than IM diclofenac for renal colic pain relief. Given it has fewer injection site side effects IM piroxicam should replace IM diclofenac for renal colic.
References:
- Al-Waili NS and Saloom KY.. Intramuscular piroxicam versus intramuscular diclofenac sodium in the treatment of acute renal colic: double-blind study.