• 
• 

Three Part Question

In [a patient with renal colic] is [buscopan (hyoscine butylbromide) better than analgesics] at [controlling pain]?

Clinical Scenario

A 38 year old man presents with moderate to severe left sided renal colic. He is known to suffer from renal stones. Examination reveals mild loin tenderness and there is blood in the urine. Oral analgesia seems unlikely to control his pain. You speak to a colleague who suggests that you use buscopan (hyoscine butylbromide) - an antispasmodic. You wonder if there is any evidence that this works.

Search Strategy

Medline 1966-10/03 using the OVID interface on ATHENS including non-indexed citations and Medline in progress
([exp kidney calculi OR exp kidney diseases OR exp ureteral calculi} AND {exp pain OR ache$.mp OR pain$.mp OR exp colic OR colic.mp}] OR renal colic.mp) AND {exp butylscopolammonium bromide OR buscopan.mp OR exp scopolamine or hyoscine.mp OR exp scopolamine derivatives OR hyoscine butylbromide.mp} LIMIT to human and english language.

Search Outcome

6 papers found of which 1 was relevant.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
al-Waili NS and Saloom KY, 1998, UAE	47 patients with acute renal colic Tenoxicam 25mg vs buscopan compositum	PRCT	Improvement in pain at 1 hr	80% for tenoxicam vs 72.7% for buscopan	Small numbers
			Relapse within 24 hrs	0% for tenoxicam vs 62% for buscopan

Comment(s)

There is only one small study in this area.

Editor Comment

Search redone in 10/03 by web editor. One possible new paper found (though possibly not relevant to the clinical question). The new paper has been requested and will be included shortly if relevant. 14/11/03

Clinical Bottom Line

Buscopan is less effective than non-steroidal antiinflammatory agents in renal colic.

Level of Evidence

Level 3 - Small numbers of small studies or great heterogeneity or very different population.

References

1. al-Waili NS, Saloom KY. Intravenous tenoxicam to treat acute renal colic: comparison with buscopan compositum. J Pakistan Med Assoc 1998;48(12):370-2.