Efficacy and Safety of Ketamine Versus Opiates in the Treatment of Patients with Renal Colic: A Systematic Review and Meta-analysis

Dongxu Zhang; Pu Liang; Bowen Xia; Xin Zhang; Xiaopeng Hu

doi:10.1007/s40122-023-00530-0

Efficacy and Safety of Ketamine Versus Opiates in the Treatment of Patients with Renal Colic: A Systematic Review and Meta-analysis

Pain Ther. 2023 Aug;12(4):1079-1093. doi: 10.1007/s40122-023-00530-0. Epub 2023 Jun 7.

Authors

Dongxu Zhang^#^{1

2}, Pu Liang^#^{3

4

5}, Bowen Xia^{1

2}, Xin Zhang^{1

2}, Xiaopeng Hu^{6

7}

Affiliations

¹ Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing, China.
² Institute of Urology, Capital Medical University, Beijing, China.
³ Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
⁴ Beijing Institute of Infectious Diseases, Beijing, China.
⁵ National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People's Republic of China.
⁶ Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing, China. xiaopeng_hu@sina.com.
⁷ Institute of Urology, Capital Medical University, Beijing, China. xiaopeng_hu@sina.com.

^# Contributed equally.

Abstract

Introduction: Renal colic is one of the most common urological emergencies, and is usually caused by ureteral colic spasms. Pain management in renal colic remains the central focus of emergency treatment. The purpose of this meta-analysis is to identify the efficacy and safety of ketamine versus opioids in the treatment of patients with renal colic.

Methods: We searched PubMed, EMBASE, Cochrane Library, and Web of Science databases for published randomized controlled trials (RCTs) that referred to the use of ketamine and opioids for patients with renal colic. The methodology was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The mean difference (MD) or odds ratio (OR) with a 95% confidence interval (CI) was used to analyze the data. The results were pooled using a fixed-effects model or random-effects model. The primary outcome measure was patient-reported pain scores 5, 15, 30, and 60 min after drug administration. The secondary outcome measure was side effects.

Results: The data analysis revealed that ketamine was similar to opioids in pain intensity at the time of 5 min post-dose (MD = - 0.40, 95% CI - 1.82 to 1.01, P = 0.57), 15 min post-dose (MD = - 0.15, 95% CI - 0.82 to 0.52, P = 0.67), 30 min post-dose (MD = 0.38, 95% CI - 0.25 to 1.01, P = 0.24). Also, the pain score of ketamine was better than that of opioids at 60 min after administration (MD = - 0.12, 95% CI - 0.22 to - 0.02, P = 0.02). As for safety, the ketamine group was linked to a significant decrease in the incidence of hypotensive (OR = 0.08, 95% CI 0.01-0.65, P = 0.02). The two groups did not statistically differ in the incidence of nausea, vomiting, and dizziness.

Conclusions: Compared with opioids, ketamine showed a longer duration of analgesia in renal colic, with satisfactory safety.

Trial registration: The PROSPERO registration number is CRD42022355246.

Keywords: Emergency; Ketamine; Kidney calculi; Meta-analysis; Opioid peptides; Pain management; Randomized controlled trial; Renal colic; Systematic review.