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Flank Pain

Date Last Search Run: Feb 01, 2022
Table last updated: Apr 02, 2022
Data last added: Mar 19, 2022

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)      
2 (fair evidence exists)      
3 (weak evidence exists)      


Interventions

Acetaminophen IV
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Pain relief Patient ED-MD Al B, Sunar MM, Zengin S, Sabak M, Bogan M, Can B, et al. Comparison of IV dexketoprofen trometamol, fentanyl, and paracetamol in the treatment of renal colic in the ED: A randomized controlled trial. Am J Emerg Med 2018; 36(4):571-6. Medline
I Supportive (Green) Decrease in pain Patient ED-MD Bektas F., Eken C., Karadeniz O., Goksu E., Cubuk M., Cete Y. Intravenous paracetamol or morphine for the treatment of renal colic: A randomized, placebo-controlled trial. Ann Emerg Med 2009; 54(4):568-74. Medline

Analgesia (narcotic)
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) VAS score Patient ED-MD Al B, Sunar MM, Zengin S, Sabak M, Bogan M, Can B, et al. Comparison of IV dexketoprofen trometamol, fentanyl, and paracetamol in the treatment of renal colic in the ED: A randomized controlled trial. Am J Emerg Med 2018; 36(4):571-6. Medline
I Supportive (Green) Pain relief Patient ED-MD Miller JP., Schauer SG., Ganem VJ., Bebarta VS. Low-dose ketamine vs morphine for acute pain in the ED: A randomized controlled trial. Am J Emerg Med 2015; 33(3):402-8. Medline
I Supportive (Green) Analgesia Patient ED-MD Safdar B., et al. IV morphine plus ketorolac is superior to either drug alone for treatment of acute renal colic. Ann Emerg Med 2006; 48:173-81. Medline
I Supportive (Green) Pain scores (using VAS) Patient ED-MD Soleimanpour H., Hassanzadeh K., Vaezi H., Golzari SE., Esfanjani RM., Soleimanpour M. Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department. BMC Urol 2012; 12:13-2490-12-13. Medline
III Supportive (Green) Efficacy Patient ED-MD O'Connor A., Schug SA., Cardwell H. A comparison of the efficacy and safety of morphine and pethidine as analgesia for suspected renal colic in the emergency setting. J Accid Emerg Med 2000; 17(4):261-4. Medline

Analgesia (NSAIDs)
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) VAS score difference at 30 minutes Patient ED-MD Cevik E., Cinar O., Salman N., et al. Comparing the efficacy of intravenous tenoxicam, lornoxicam, and dexketoprofen trometamol for the treatment of renal colic. Am J Emerg Med 2012; 30(8):1486-90. Medline
I Supportive (Green) Alleviation of pain Patient ED-MD Eidinejad L, Bahreini M, Ahmadi A, Yazdchi M, Thiruganasambandamoorthy V, Mirfazaelian H. Comparison of intravenous ketorolac at three doses for treating renal colic in the emergency department: A noninferiority randomized controlled trial. Acad Emerg Med 2021; 28(7):768–75. Medline
I Supportive (Green) Pain relief Patient ED-MD Labrecque M., Dostaler LP., Rousselle R., Nguyen T., Poirier S. Efficacy of nonsteroidal anti-inflammatory drugs in the treatment of acute renal colic. A meta-analysis. Arch Intern Med 1994; 154:1381-7. Medline
I Supportive (Green) Pain reduction at 30 mins Patient ED-MD Motov S, Yasavolian M, Likourezos A, Pushkar I, Hossain R, Drapkin J, et al. Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department A Randomized Controlled Trial. Ann Emerg Med 2017; 70(2) 177-84. Medline
I Supportive (Green) Analgesia Patient ED-MD Safdar B., et al. IV morphine plus ketorolac is superior to either drug alone for treatment of acute renal colic. Ann Emerg Med 2006; 48:173-81. Medline

Ketamine
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Pain scale Patient ED-MD Abbasi S, Bidi N, Mahshidfar B, Hafezimoghadam P, Rezai M, Mofidi M, et al. Can low-dose of ketamine reduce the need for morphine in renal colic? A double-blind randomized clinical trial. Am J Emerg Med 2018; 36(3) 376-9. Medline
I Supportive (Green) Analgesia Patient ED-MD Farnia MR, Jalali A, Vahidi E, Momeni M, Seyedhosseini J, Saeedi M. Comparison of intranasal ketamine versus IV morphine in reducing pain in patients with renal colic. Am J Emerg Med 2017; 35(3):434-7. Medline
I Supportive (Green) Pain relief Patient ED-MD Miller JP., Schauer SG., Ganem VJ., Bebarta VS. Low-dose ketamine vs morphine for acute pain in the ED: A randomized controlled trial. Am J Emerg Med 2015; 33(3):402-8. Medline

Morphine
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Decrease in pain Patient ED-MD Bektas F., Eken C., Karadeniz O., Goksu E., Cubuk M., Cete Y. Intravenous paracetamol or morphine for the treatment of renal colic: A randomized, placebo-controlled trial. Ann Emerg Med 2009; 54(4):568-74. Medline
I Supportive (Green) Changes in VAS score Patient ED-MD Farnia MR, Jalali A, Vahidi E, Momeni M, Seyedhosseini J, Saeedi M. Comparison of intranasal ketamine versus IV morphine in reducing pain in patients with renal colic. Am J Emerg Med 2017; 35(3):434-7. Medline
I Supportive (Green) Pain reduction at 20, 40 minutes Patient ED-MD Hosseininejad SM, Jahanian F, Erfanian Irankar S, Moosazadeh M, Hosseini SA, Shahbakhti N, et al. Comparing the analgesic efficacy of morphine plus ketamine versus morphine plus placebo in patients with acute renal colic: A double-blinded randomized controlled trial. Am J Emerg Med 2019; 37(6):1118-23. Medline


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