Jaballah Rahma, Toumia Marwa, Youssef Rym, Ali Khaoula Bel Haj, Bakir Arij, Sassi Sarra, Yaakoubi Hajer, Kouraichi Cyrine, Dhaoui Randa, Sekma Adel, Zorgati Asma, Beltaief Kaouthar, Mezgar Zied, Khrouf Mariem, Bouida Wahid, Grissa Mohamed Habib, Saad Jamel, Boubaker Hamdi, Boukef Riadh, Msolli Mohamed Amine, Nouira Semir
Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia.
Emergency Department, Sahloul University Hospital, Sousse, Tunisia.
Acad Emerg Med. 2025 Feb;32(2):158-164. doi: 10.1111/acem.14996. Epub 2024 Aug 19.
Renal colic (RC) is a common urologic emergency often leading to significant pain and recurrent hospital visits. This study aimed to compare the efficacy and safety of piroxicam versus paracetamol in preventing pain recurrence and hospital readmission in patients treated for RC and discharged from the emergency department (ED).
A prospective, randomized, single-blind trial was conducted in four EDs. Eligible adults with RC were randomized to receive oral piroxicam, paracetamol, or placebo for 5 days post-ED discharge. Primary outcomes included pain recurrence and ED readmission within 7 days. Secondary outcomes included time to recurrence and treatment-related side effects.
Of 1383 enrolled patients, no significant differences were observed among the groups regarding baseline characteristics. Pain recurrence rates within 7 days were 29% (95% confidence interval [CI] 24.9%-33.2%) for piroxicam, 30.3% (95% CI 26.1%-34.5%) for paracetamol, and 30.8% (95% CI 26.6%-35.0%) for placebo, with no significant between-group differences (p = 0.84). Among patients experiencing recurrence, the majority encounter it within the initial 2 days following their discharge (86% in the piroxicam group, 84.1% in the paracetamol group, and 86% in the placebo group, respectively). ED readmission rates were similar across groups: 20.8% (95% CI 17.1%-24.5%) in the piroxicam group, 23.8% (95% CI 19.9%-27.7%) in the paracetamol group, and 22.9% (95% CI 19.1%-26.8%) in the placebo group (p = 0.52). The piroxicam group reported significantly higher adverse effects compared to others.
Piroxicam and paracetamol did not demonstrate efficacy in preventing pain recurrence or ED readmission within the first week following RC treatment.
肾绞痛（RC）是一种常见的泌尿外科急症，常导致严重疼痛和反复就诊。本研究旨在比较吡罗昔康与对乙酰氨基酚在预防RC治疗后出院的患者疼痛复发和再次入院方面的疗效和安全性。
在四个急诊科进行了一项前瞻性、随机、单盲试验。符合条件的成年RC患者在急诊出院后随机接受口服吡罗昔康、对乙酰氨基酚或安慰剂，为期5天。主要结局包括7天内的疼痛复发和再次急诊入院。次要结局包括复发时间和治疗相关的副作用。
在1383名入组患者中，各治疗组间的基线特征无显著差异。吡罗昔康组7天内的疼痛复发率为29%（95%置信区间[CI]24.9%-33.2%），对乙酰氨基酚组为30.3%（95%CI 26.1%-34.5%），安慰剂组为30.8%（95%CI 26.6%-35.0%），组间差异无统计学意义（p = 0.84）。在出现复发的患者中，大多数在出院后的头2天内复发（吡罗昔康组为86%，对乙酰氨基酚组为84.1%，安慰剂组为86%）。各组的再次急诊入院率相似：吡罗昔康组为20.8%（95%CI 17.1%-24.5%），对乙酰氨基酚组为23.8%（95%CI 19.9%-27.7%），安慰剂组为22.9%（95%CI 19.1%-26.8%）（p = 0.52）。与其他组相比，吡罗昔康组报告的不良反应显著更高。
吡罗昔康和对乙酰氨基酚在预防RC治疗后第一周内的疼痛复发或再次急诊入院方面均未显示出疗效。
