Exploring intradermal sterile water injection as an alternative to natrium diclofenac for kidney-stone related pain relief: A systematic review and meta-analysis of randomized controlled trials.

Background: Kidney stone-related pain often presents significant challenges in clinical practice, mainly due to the adverse effects by NSAIDs, which are the current first-line treatment for urolithiasis. Patients presenting with gastrointestinal tract disorders and contraindications toward NSAIDs are particularly susceptible. Intradermal sterile water injection (SWI) has evidently become apparent as one of the promising alternatives, offering rapid pain relief with minimal adverse effects. This purpose of this study to assess the safety and efficacy of SWI in comparison to NSAIDs particularly Natrium Diclofenac in the management of kidney-stone related pain.

Main body: A systematic review and meta-analysis was performed on papers published up to January 2024 obtained from scientific databases, guided by the PRISMA flowchart. The Cochrane risk of bias 2.0 tool was used to assess quality of the included studies. Statistical analyses were then performed using Review Manager 5.4.1 on studies that provide the baseline and complete follow-up numerical outcomes (e.g. mean and standard deviation) required. After screening was done, 3 retrievable studies met the inclusion and exclusion criteria with a total of 770 participants with kidney stone related pain. The result revealed no significant difference in pain reduction between SWI and Natrium diclofenac at 30 min (MD -0.12, 95% CI -0.68 to 0.44) and 60 min (MD -0.23, 95% CI -0.65 to 0.18). Furthermore, patients treated with SWI display a reduced need for rescue analgesia compared to Natrium Diclofenac (OR 0.73, 95% CI 0.36 to 1.49). Adverse events result was more superior in SWI, having lower occurrence when compared to Natrium Diclofenac, although not significant (OR 0.14, 95% CI 0.05 to 0.39).

Conclusions: Intradermal sterile water injection (SWI) appears to be a promising alternative to NSAIDs for kidney stone related pain management, offering comparable efficacy in pain reduction, reduced need for rescue analgesia while maintaining a favorable safety profile. However, further research with larger sample sizes and standardized treatment protocols are required to further validate its safety and efficacy.