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Renal Colic in the ED - Analgesia

Systemic NSAID's such as oral ibuprofen or rectal indomethacin are the specific agents of choice for renal colic as the pain is prostaglandin mediated.

Route of administration is not related to efficacy but rectal indomethacin is preferable if the patient is vomiting.

Intravenous (morphine or fentanyl) or oral (oxycodone) opiods may provide immediate analgesia while awaiting the onset of action of NSAIDs. Intravenous NSAIDs (eg ketoralac) are an rarely used alternative but caution is advised in patients with renal impairment. Paracetamol should also be started as part of the analgesia regimen.

Use the Pain Management Factsheet to pescribe discharge medications.


Significantly dehydrated patients with vomiting may require replacement +/- maintenance IV fluids, but fluid administration is not routine therapy for renal colic as it does not facilitate stone passage and may worsen pain secondary to renal capsular distension.

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