Ketorolac plus dexamethasone is more effective for pain relief than ketorolac alone in adults with renal colic

Reference

Razi A, Farrokhi E, Lotfabadi P, et al. Dexamethasone and ketorolac compare with ketorolac alone in acute renal colic: A randomized clinical trial. Am J Emerg Med 2022;58:245-250.

Synopsis

For this study that took place in a single emergency department in Iran, the researchers enrolled adults with acute renal colic whose pain intensity was greater than 5 on a visual analog scale of 1 – 10. The participants’ stones were confirmed by laboratory and radiographic findings. The researchers randomized the participants to receive a single dose of intravenous ketorolac 30 mg plus placebo (n = 60) or ketorolac plus dexamethasone (8 mg; n = 60). On average, the age of the participants was in the mid-30s, and they were in severe pain (median 9.5/10). After 30 minutes both groups of participants achieved meaningful reductions in pain scores and those receiving dexamethasone had greater reductions than those receiving placebo (-5/10 vs -3/10). However, after an hour the differences were no longer statistically significant (-7/10 vs -5/10; P = .068). This latter difference is clinically meaningful and suggests the study was too small. During the hour after initial treatment, 21 patients (35%) who received dexamethasone and 35 patients (58%) who received placebo also received a narcotic (number needed to treat [NNT] = 5; 95% CI 3 - 19). Many persons with renal colic also experience nausea. The participants who received dexamethasone were less likely to receive an antiemetic during the hour after initial treatment (12% vs 28%; NNT = 6; 95% CI 4 - 44). Although this appears to be the first study published on using dexamethasone in persons with renal colic, the authors point out its effectiveness as an adjunct for painful musculoskeletal conditions. Finally, this single-site study is too small to detect uncommon harms associated with corticosteroid use.