• Rahma Jaballah, Marwa Toumia, Rym Youssef, AliKhaoula Bel HajKBHResearch Laboratory LR12SP18, Monastir University, Monastir, Tunisia.Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia., Arij Bakir, Sarra Sassi, Hajer Yaakoubi, Cyrine Kouraichi, Randa Dhaoui, Adel Sekma, Asma Zorgati, Kaouthar Beltaief, Zied Mezgar, Mariem Khrouf, Wahid Bouida, Mohamed Habib Grissa, Jamel Saad, Hamdi Boubaker, Riadh Boukef, Mohamed Amine Msolli, and Semir Nouira.
• Research Laboratory LR12SP18, Monastir University, Monastir, Tunisia.
• Acad Emerg Med. 2024 Aug 19.

ObjectiveRenal colic (RC) is a common urologic emergency often leading to significant pain and recurrent hospital visits. This study aimed to compare the efficacy and safety of piroxicam versus paracetamol in preventing pain recurrence and hospital readmission in patients treated for RC and discharged from the emergency department (ED).MethodsA prospective, randomized, single-blind trial was conducted in four EDs. Eligible adults with RC were randomized to receive oral piroxicam, paracetamol, or placebo for 5 days post-ED discharge. Primary outcomes included pain recurrence and ED readmission within 7 days. Secondary outcomes included time to recurrence and treatment-related side effects.ResultsOf 1383 enrolled patients, no significant differences were observed among the groups regarding baseline characteristics. Pain recurrence rates within 7 days were 29% (95% confidence interval [CI] 24.9%-33.2%) for piroxicam, 30.3% (95% CI 26.1%-34.5%) for paracetamol, and 30.8% (95% CI 26.6%-35.0%) for placebo, with no significant between-group differences (p = 0.84). Among patients experiencing recurrence, the majority encounter it within the initial 2 days following their discharge (86% in the piroxicam group, 84.1% in the paracetamol group, and 86% in the placebo group, respectively). ED readmission rates were similar across groups: 20.8% (95% CI 17.1%-24.5%) in the piroxicam group, 23.8% (95% CI 19.9%-27.7%) in the paracetamol group, and 22.9% (95% CI 19.1%-26.8%) in the placebo group (p = 0.52). The piroxicam group reported significantly higher adverse effects compared to others.ConclusionsPiroxicam and paracetamol did not demonstrate efficacy in preventing pain recurrence or ED readmission within the first week following RC treatment.© 2024 The Author(s). Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.

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