Ketorolac for kidney stone pain: a systematic review and meta-analysis

Renal colic due to nephrolithiasis is a common cause of acute pain, affecting a significant proportion of the population. The primary mechanism involves ureteric obstruction by calculi, leading to increased intraluminal pressure, smooth muscle contraction, and the release of inflammatory mediators. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ketorolac, are widely used for pain management due to their anti-inflammatory and analgesic effects. This systematic review and meta-analysis aims to assess the efficacy and safety of ketorolac compared with other drugs for managing pain associated with kidney stones. A systematic search was conducted using PubMed, Scopus, and Google Scholar for Randomized controlled trials (RCTs) or observational studies comparing ketorolac with placebo or other analgesic treatments for kidney stone pain. Two independent reviewers screened the studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias Tool for RCTs and the Newcastle–Ottawa Scale for observational studies. A total of 39 studies comprising 5707 patients were included. Our meta-analysis found that ketorolac resulted in both statistically significant and clinically significant pain reduction after 15 min (− 2.8, 95% CI= [− 3.28; − 2.31]), 30 min (− 4.77, CI= [− 5.12; − 4.42]), 45 min (− 4.91, 95% CI= [− 5.68; − 4.13]), and 60 min (− 6.00, 95% CI= [− 6.53; − 5.46]). These results were regardless of the combination with other drugs, which, in subgroup analysis, did not show a difference from ketorolac alone. In the pairwise meta-analysis of the ketorolac alone compared to others (opioid-, NSAIDs-, or others- based therapy), the results showed slightly lower pain scores. However, these results were neither statistically nor clinically significant. Hence, ketorolac has comparable efficacy compared to other drug classes, including NSAIDs. In terms of safety, ketorolac's side effect profile is similar to that of other drugs used to treat renal colic. Ketorolac is an effective and well-tolerated option for managing kidney stone pain. Further large-scale RCTs are needed to refine treatment recommendations.