Introduction: In adults presenting to the emergency department with biliary colic, is treatment with non-steroid anti-inflammatory drugs (NSAIDs) safer and more effective than treatment with other analgesics? The aim of this study was to answer this clinical question by means of a systematic review and meta-analysis of randomized controlled trials (RCT).
Methods: A systematic search for RCT was performed in Medline, Central, ClinicalTrials.gov, Lilacs, Teseo, and IME. A manual search was carried out in the references of retrieved articles and through contact with the authors of the RCT. All RCT comparing NSAIDs with any other active intervention in adults diagnosed with uncomplicated biliary colic were included. Outcome measures consisted of rescue analgesia, the rapidity of analgesic effect, progression to acute cholecystitis, and adverse effects. The RevMan program was used with a fixed effects model. The results were expressed as odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was analyzed with the chi-squared test with a statistical significance level of p < or = 0.10.
Results: Seven RCT were selected, with 349 patients. Comparison between NSAIDs and all the other analgesics showed a benefit in favor of NSAIDs with a lower need for rescue analgesia (OR = 0.32; 95% CI, 0.16-0.61) and less progression to acute cholecystitis (OR = 0.19; 95% CI, 0.08-0.44).
Conclusion: NSAIDs are the analgesics of choice in uncomplicated biliary colic since these drugs are more effective than other analgesics and can improve prognosis, limiting progression of colic to acute cholecystitis.