Management of Acute Renal Colic

First-Line Treatment: NSAIDs

The European Association of Urology recommends NSAIDs, specifically diclofenac 75 mg intramuscularly, as the first-line treatment for acute renal colic, providing superior pain relief compared to opioids while reducing the need for additional analgesia and causing fewer side effects 1, 2, 3
Diclofenac 75 mg intramuscularly is the preferred initial analgesic when the diagnosis is clear and there are no contraindications, according to the British Medical Journal 4, 1
NSAIDs work by providing analgesia and decreasing ureteral smooth muscle tone and spasm that contribute to kidney stone pain, as stated by the European Urology association 2
The lowest effective dose of NSAIDs should be used due to potential cardiovascular and gastrointestinal risks, as recommended by the European Urology association 1

Patients with low glomerular filtration rate or renal impairment should be screened carefully before prescribing NSAIDs, as they are contraindicated in these cases, according to the European Urology association 1

Opioids should be reserved for patients who cannot tolerate NSAIDs or when NSAIDs fail to control pain within one hour, as recommended by the British Medical Journal and the European Urology association 4, 1
Hydromorphine, pentazocine, or tramadol can be used, but not pethidine, which causes higher rates of vomiting and need for additional analgesia, according to the European Urology association 1, 3
Morphine sulfate combined with an antiemetic, such as cyclizine, is recommended when opioids are necessary, as stated by the British Medical Journal 4
Before prescribing opioids, the risk of substance abuse should be assessed and informed consent obtained, as recommended by the Praxis Medical Insights 2

Analgesia should provide pain relief within 30 minutes of administration, and if severe pain does not remit within one hour, the patient should be immediately admitted to the hospital, as recommended by the British Medical Journal 4, 5
Follow-up with a telephone call one hour after initial assessment to check analgesic effectiveness is recommended, according to the British Medical Journal 4

Patients should be instructed to increase fluid intake significantly to facilitate stone passage, as recommended by the British Medical Journal and the Praxis Medical Insights 4, 2