Antispasmodic and analgesic strategies for renal colic in pregnancy: a comprehensive analysis.

BACKGROUND

Analgesia remains the paramount priority in the clinical management of gestational renal colic, yet established protocols are frequently constrained by contraindications. While antispasmodic intervention emerges as a viable alternative, the definitive pharmacological choice remains elusive. Here, we evaluated the effectiveness and safety of commonly used antispasmodic and analgesic strategies for pregnancy-related renal colic using network and pairwise meta-analyses.

METHOD: A literature review was undertaken utilizing three English-language databases and four Chinese-language databases, encompassing publications up to 1 January 2025. Randomized controlled trials (RCTs) that satisfied the inclusion criteria were selected for analysis. The Cochrane Risk-of-Bias Tool was employed to evaluate the risk of bias. Statistical analyses were performed, encompassing intervention comparison and ranking, assessment of consistency and heterogeneity, evaluation of publication bias, as well as meta-regression, subgroup, and sensitivity analyses.

RESULTS

The study included ten RCTs with 936 patients. Four dimensions for the RCTs had a low risk of bias, with one dimension having "some concerns." In network meta-analyses, phloroglucinol was most effective in relieving pain within 1 h, followed by progesterone, while anisodamine was least effective. Phloroglucinol caused the least side effects like nausea and dizziness compared to progesterone and anisodamine. In pairwise meta-analyses, phloroglucinol had a lower 6-h pain recurrence rate and fewer side effects like blurred vision and palpitations than anisodamine. Variations in phloroglucinol dosage contributed to heterogeneity, but subgroup and sensitivity analyses confirmed result stability.

CONCLUSION

Phloroglucinol is the preferred treatment for renal colic pain during pregnancy due to its efficacy and safety. It can be combined with progesterone, but anisodamine is not advised. Further high-quality research is necessary to confirm this finding.

CLINICAL TRIAL REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42022377502.