Diclofenac versus Tramadol in the Treatment of Renal Colic: A Prospective, Randomized Trial

ABSTRACT

Objective: Nonsteroidal anti-inflammatory drugs are considered the mainstay in the treatment of renal colic. Nonsteroidal anti-inflammatory drugs are contraindicated in patients with renal failure and are not recommended in patients with certain diseases. In these cases other analgesics should be used. The aim of our study was to compare the analgesic efficacy of intramuscular Diclofenac and Tramadol in the treatment of renal colic in our emergency department.

Methods: A prospective, randomized trial was conducted in patients with a clinical picture of renal colic. Diagnosis was confirmed by non contrast abdominal computed tomography. Subjects were randomized to receive a single intramuscular injection of either 75 mg Diclofenac or 100 mg Tramadol. Ninety seven patients were included, of these 48 received Diclofenac and 49 received Tramadol.

Results: Patients’ characteristics including average stone size and degree of hydronephrosis were similar at enrollment. Diclofenac was significantly more effective than Tramadol in reducing the severity of pain at 30 minutes as measured on a 10-cm visual analogue scale. Reduction of more than 50% in pain severity was observed in 64% of patients treated with Diclofenac and in 49% of patients treated with Tramadol (P < 0.05). More patients in the Tramadol group needed rescue analgesia: 51% vs 21(p< 0.05). For all the study variables, Diclofenac was better than Tramadol

Conclusions: Intramuscular Diclofenac as a single agent for the treatment of renal colic is more effective than intramuscular Tramadol in our patients. Intramuscular Tramadol may be an alternative when contraindications preclude the use of Diclofenac.

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