Opioid-free analgesia for acute renal colic: a randomized, double-blind, head-to-head comparison of intravenous ibuprofen, dexketoprofen trometamol and paracetamol in the emergency department
In brief
IV dexketoprofen lowered renal-colic pain 9.5 points more than paracetamol
In a randomized trial of 251 adults, adjusted pain scores at 30 minutes were 9.5 points lower on a 100-point scale with dexketoprofen than with paracetamol. About two-thirds to three-quarters in each group achieved at least 50% pain reduction, with no significant difference between treatments; the single-centre findings leave the practical importance of the score difference uncertain.
- Journal
- Internal and emergency medicine (Q1)
- Published
- 30 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Muhammet Mustafa Yılmaz, Çağatay Han Türkseven, Muhammed Alkaya, Uğur Lök
- PMID
- 42961621
- DOI
- 10.1007/s11739-026-04579-5
Why clinicians should know about it
- Picked for Emergency Medicine (paper of the day, 31 October 2026): Randomized ED trial directly compares acute renal colic analgesia
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are first-line analgesics for acute renal colic, but comparisons of the intravenous (IV) non-opioid agents used in emergency departments are scarce. In this prospective, single-centre, randomized, double-blind, three-arm trial, 251 adults with acute renal colic received IV ibuprofen 400 mg (n = 86), dexketoprofen trometamol 50 mg (n = 82) or paracetamol 1 g (n = 83) infused over 15 min. Pain was scored on a 100-mm visual analogue scale (VAS) at 0, 15 and 30 min; the primary outcome was treatment success (≥50% VAS reduction at 30 min). Treatment success occurred in 76.7%, 74.4% and 66.3%, respectively (p = 0.280); mean VAS reduction at 30 min was 51.1, 56.5 and 45.5 mm. Baseline VAS was higher with dexketoprofen (85.2 vs 78.0 and 79.8 mm; p = 0.025); after adjustment for baseline, VAS at 30 min was lowest with dexketoprofen (25.6 mm), intermediate with ibuprofen (29.0 mm) and highest with paracetamol (35.1 mm; dexketoprofen vs paracetamol -9.5 mm, 95% confidence interval (CI) -16.5 to -2.5; p = 0.023). Rescue fentanyl was required in 32.6%, 31.7% and 43.4% (p = 0.217); the adjusted odds were lower with dexketoprofen than with paracetamol (odds ratio 0.40, 95% CI 0.20-0.84). Mild nausea or dizziness occurred in 3.5%, 3.7% and 3.6% of patients; none was serious. All three agents provided effective opioid-free analgesia; dexketoprofen produced the largest adjusted pain reduction and the lowest need for rescue opioid, ibuprofen was comparable and paracetamol least effective. Trial registration: not registered (see Methods).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.