A Prospective Comparative Study of Intramuscular Diclofenac versus Intravenous Tramadol for Acute Ureteric Colic in the Emergency Department of Rama Medical College Hospital and Research Centre

Abstract

Objective: The present study is done to comparatively assess the efficacy & safety in terms of relief time achieved by administering intramuscular Diclofenac 75mg and Intravenous Tramadol 50mg in patients of ureteric colic presenting in Emergency department.
Background:
Acute ureteric colic is a severe and debilitating pain commonly encountered in emergency departments, often caused by ureteral stones. Effective and rapid pain management is critical for improving patient outcomes.
Methods:
A prospective, double-blind, randomized controlled trial was conducted in the Emergency Department of Rama Medical College Hospital and Research Centre. Patient presenting with acute pain in lumbar region with or without radiation to genitals, and with (hydronephrosis and/or stone visualisation on point-of-care ultrasound) in the ED were randomly assigned to receive an intramuscular Diclofenac 75mg (IM) or Intravenous Tramadol 50mg (IV). A total of 120 patients aged 12–60 years with acute ureteric colic and a Visual Analog Scale (VAS) pain score ≥7 were randomized into two groups: Group A received intramuscular diclofenac (75 mg), and Group B received intravenous tramadol (50 mg). Pain scores were recorded at baseline, 15, 30, 60, and 120 minutes post-administration. Adverse effects were documented. Statistical analysis was performed using SPSS v.25.0.
Results:
Group A (diclofenac) demonstrated significantly faster and more effective pain relief compared to Group B (tramadol) at all time intervals (p < 0.01). At 15 minutes, mean VAS scores were 4.3 ± 1.0 for diclofenac and 6.2 ± 1.1 for tramadol. By 120 minutes, the VAS score reduced to 0.5 ± 0.2 in the diclofenac group versus 2.2 ± 0.6 in the tramadol group. Adverse effects were significantly higher in the tramadol group, including nausea (33.3%), vomiting (20%), and dizziness (16.6%).
Conclusion:
Intramuscular diclofenac is superior and safe to intravenous tramadol for the management of acute ureteric colic, providing faster pain relief with fewer adverse effects. Diclofenac should be the preferred first-line treatment in emergency settings for acute ureteric colic.