Effect of Diclofenac Alone in Comparison with Diclofenac plus Paracetamol on Renal Colic in Emergency Department

Abstract

Background: Renal colic is one of the most prevalent diagnoses made in emergency unit, consequently, the use of effective pain killers like; non-steroidal anti-inflammatory drugs, or a combination of medications, play important roles in the treatment of these patients.

Objective: To compare effectiveness of paracetamol plus diclofenac vs diclofenac alone in treatment of renal colic. Patients and Methods: A single center double blinded-randomized clinical trial that conducted between the first of January and the first of March of 2022 among patients attending the emergency department of AL-Hilla teaching hospital at babil governorate. A total of 160 patients with definite diagnosis of renal colic with documented renal stone were asked to participate in this study, and excluded all asthmatic patient or peptic ulcer or duodenal ulcer and hypertensive patients. The patients were blindly and randomly divided into two equal groups, the first group received intravenous paracetamol (1g/100ml) plus intramuscular diclofenac (75mg/3ml) and second group received intramuscular diclofenac (75mg/ml) alone, the intensity of pain was measured after 10, 30, 60, 120 minute after administration of medication by numerical rating scale. Results: A total of 160 patients with renal colic were enrolled in this study. The two group were identical in term of age, gender. The difference in the mean numerical rating scale between two groups shown no significant difference before treatment, after 10, 30, 60 minutes (p=0.966, 0.097, 0.38 and 0.59 respectively), while there was a significant difference in the mean NRS after 120 minute (p=0.01) where the mean numerical rating scale was lower at diclofenac plus paracetamol group (mean 0.77) vs diclofenac only group (mean 1.51), Failure to relieve pain in renal colic, after 120 minute was found among 6.25% of diclofenac only group and among 3.75% of patients with diclofenac pulse paracetamol. Conclusion: The mean numerical rating scale was lower at diclofenac plus paracetamol group vs diclofenac only group after 120 minute only and the percentage of failure to relieve pain was lower in diclofenac plus paracetamol group.