Published 2021-01-15
Eko Arianto Arry Rodjani Irfan Wahyudi


Objective: The purpose of this study is to compare which analgesic is better between ketorolac and diclofenac. Material & Methods: A systematic search was conducted in Pubmed, Science Direct, Cochrane, EBSCO, Proquest database, and PICO analysis was used in determining the study question. The included article in the analysis was randomized controlled trials. Results: A total of 6 articles were included in the analysis, with no significant differences between ketorolac and diclofenac both in a direct comparison and indirect comparison (OR 2.74 [95%CI 0.72 – 10.43]; p= 0.14 and OR 0.51 [95%CI 0.29 – 0.91]; p= 0.49). Conclusion: Both ketorolac and diclofenac have the same efficacy in treating renal colic.



diclofenac, renal coli, ketorolac


Schubert H. Emergency case. Can Fam Physician. 2000; 46: 1759–61.

Golzari SE, Soleimanpour H, Rahmani F, Zamani Mehr N, Safari S, Heshmat Y, et al. Therapeutic Approaches for Renal Colic in the Emergency Department: A Review Article. Anesthesiol pain Med. 2014; 4(1): e16222.

Oertel BG, Loetsch J. Clinical pharmacology of analgesics assessed with human experimental pain models: Bridging basic and clinical research. Br J Pharmacol. 2013; 168(3): 534–53.

Davenport K, Waine E. The role of non-steroidal anti-inflammatory drugs in renal colic. Pharmaceuticals. 2010; 3(5): 1304–10.

Oosterlinck W, Philp N, Charig C, Gillies G, Hetherington J, Lloyd J. A Double-Blind Single Dose Comparison Intramuscular Ketorolac Tromethamine and Pethidine in the Treatment of Renal Colic. J Clin Pharmacol. 1990; 30: 336–41.

Sandhu D, Iacovou J, Fletcher M, Kaisary A, Philip N, Arkell D. A comparison of intramuscular ketorolac and pethidine in the alleviation of renal colic. Br J Urol. 1994; 74: 690–3.

Arnau J, Cami J, Garcia-Alonso F, Laporte J, Palop R. Comparative study of the efficacy of dipyrone , diclofenac sodium and pethidine in acute renal colic. Eur J Clin. 1991; 40: 543–6.

Marthak K V, Gokarn A, Rao A, Sane P, Mahanta R, Sheth R, et al. A Multi-Centre Comparative Study of Diclofenac Sodium and a Dipyrone/Spasmolytic Combination, and A Single-Centre Comparative Study of Diclofenac Sodium and Pethidine in Renal Colic Patients in India. Curr Med Res Opin. 1991; 12(6): 366–73.

Hetherington J, Philp N. SHORT REPORTS Diclofenac sodium versus pethidine in acute renal colic Diarrhoea due to Clostridium difficile associated with antibiotic treatment. Br Med J. 1986; 292: 237–8.

Cohen E, Hafner R, Rotenberg Z, Fadilla M, Garty M. Comparison of ketorolac and diclofenac in the treatment of renal colic. Eur J Clin Pharmacol. 1998; 54(6): 455–8.

Bucher HC, Guyatt GH, Griffith LE, Walter SD. The Results of Direct and Indirect Treatment Comparisons in Meta-Analysis of Randomized Controlled Trials. J Clin Epidemiol. 1997; 50(6): 683–91.

Borenstein M, Hedges L V, Higgins JPT, Rothstein HR. Subgroup Analyses. In: Introduction to Meta-Analysis. 2009. p. 149–86.

Borenstein M, Hedges L V, Higgins JPT, Rothstein HR. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods. 2010; 1: 97-111.

Conaghan PG. A turbulent decade for NSAIDs : update on current concepts of classification , epidemiology , comparative efficacy , and toxicity. Rheumatol Int. 2012; 32: 1491–502.

Ong C, Lirk P, Tan CH, Seymour RA. An Evidence-Based Update on Nonsteroidal Anti-Inflammatory Drugs. Clin Med Res. 2007; 5(1): 19–34.

Castellsague J, Pisa F, Rosolen V, Drigo D, Riera-Guardia N, Giangreco M, et al. Risk of upper gastrointestinal complications in a cohort of users of nimesulide and other nonsteroidal anti-inflammatory drugs in Friuli Venezia Giulia, Italy. Pharmacoepidemiol Drug Saf. 2012; 22(4).

Feldman HI, Kinman JL, Berlin JA, Hennessy S, Kimmel SE, Farrar J, et al. Parenteral ketorolac : The risk for acute renal failure. Ann Intern Med. 1997; 126(3): 193–9.

Ingrasciotta Y, Sultana J, Giorgianni F, Fontana A, Santangelo A, Tari DU, et al. Association of Individual Non-Steroidal Anti- Inflammatory Drugs and Chronic Kidney Disease : A Population-Based Case Control Study. PLoS One. 2015; 1–14.

Holdgate A, Pollock T. Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic. BMJ. 2004; 328(7453): 1401.

Holdgate A, Pollock T. Nonsteroidal anti-inflammatory drugs ( NSAIDS ) versus opioids for acute renal colic. Cochrane Collab. Australia: John Wiley & Sons, Ltd; 2009.

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Department of Urology, Faculty of Medicine/Airlangga University