Celecoxib in the Management of Acute Renal Colic: A Randomized Controlled Clinical Trial
Received 27 December 2008; accepted 18 April 2009. published online 09 July 2009.
Objectives
To evaluate the efficacy of celecoxib as an analgesic and medical expulsive agent in acute renal colic.
Methods
A prospective randomized double-blind study was conducted on patients presenting with an obstructing ureteral calculus < 10 mm in largest diameter. Patients were randomized to 400 mg of celecoxib, followed by 200 mg every 12 hours for 10 days, or to placebo. Patients with a solitary kidney, renal insufficiency (CR > 1.8), urinary tract infection, or significant cardiovascular disease were excluded.
Results
A total of 57 patients provided consent of which 53 completed the study. Four patients were excluded from the analysis because of stone passage or withdrawal of consent before the first dose of study medication. No significant difference was noted in the spontaneous stone passage rate (celecoxib 55.2%, placebo 54.2%) and between celecoxib and placebo with regard to days to stone passage (7.0 vs 9.0, P = .6) or size of stone passed (3.9 vs 4.6 mm, P = .18). No significant difference was noted in pain analog scores (2.6 vs 3.5, P = .71) or narcotic doses (13.2 vs 13.6, P = .74). Furthermore, a 25% decrease in narcotic use (or 19 mg based on placebo mean) was outside the 80% one-sided confidence interval for the change in mean narcotic use between the 2 groups. Thus, it is unlikely (< 20%) that we missed a clinically significant beneficial effect of celecoxib on narcotic consumption because of sample size.
Conclusions
Celecoxib does not facilitate stone passage or decrease narcotic requirements in patients with acute renal colic.
Department of Urologic Surgery, University of Minnesota and VAHCS Minneapolis, Minneapolis, Minnesota
Reprint requests: Manoj Monga, M.D., Department of Urologic Surgery, 420 Delaware St SE (MMC 394), Minneapolis, MN 55455
ABSTRACT