Michael Conlin’s commentary on NSAIDs
Pain relief after ureteric stent removal: think NSAIDs
Nicholas N. Tadros, Lisa Bland, Edith Legg, Ali Olyaei and Michael J. Conlin*
Oregon Health & Science University and *Portland Veterans Administration Medical Center, Portland, OR, USA
OBJECTIVES
• To determine the incidence of severe pain after ureteric stent removal.
• To evaluate the efficacy of a single dose of a non-steroidal anti-inflammatory drug (NSAID) in preventing this complication.
PATIENTS AND METHODS
• A prospective, randomised, double-blind, placebo-controlled trial was performed at our institution.
• Adults with an indwelling ureteric stent after ureteroscopy were randomised to receive either a single dose of placebo or an NSAID (rofecoxib 50 mg) before ureteric stent removal.
• Pain was measured using a visual analogue scale (VAS) just before and 24 h after stent removal
• Pain medication use after ureteric stent removal was measured using morphine equivalents.
RESULTS
• In all, 22 patients were enrolled and randomised into the study before ending the study after interim analysis showed significant decrease in pain level in the NSAID group.
• The most common indication for ureteroscopy was urolithiasis (14 patients).
• The proportion of patients with severe pain (VAS score of ≥7) during the 24 h after ureteric stent removal was six of 11 (55%) in the placebo group and it was zero of 10 in the NSAID group (P < 0.01).
• There were no complications related to the use of rofecoxib.
CONCLUSIONS
• We found a 55% incidence of severe pain after ureteric stent removal.
• A single dose of a NSAID before stent removal prevents severe pain after ureteric stent removal.
Tadros NN, Bland L, Legg E, et al. A single dose of a non-steroidal anti-inflammatory drug (NSAID) prevents severe pain after ureteric stent removal: a prospective, randomised, double-blind, placebo-controlled trial. BJU Int 2013, 111: 101–105.
