MBE: AINE IM vs VO: diferència entre les revisions
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*Variable pain control following intermittent intramuscular meperidine injections was shown to be due to inadequate, fluctuating and unpredictable blood concentrations <cite>TD1</cite>. | *Variable pain control following intermittent intramuscular meperidine injections was shown to be due to inadequate, fluctuating and unpredictable blood concentrations <cite>TD1</cite>. | ||
*The purpose of this study was to identify patient patterns in intravenous patient-controlled analgesia (PCA) and intramuscular (IM) analgesia for patients after surgery <cite>TD2</cite>. | *The purpose of this study was to identify patient patterns in intravenous patient-controlled analgesia (PCA) and intramuscular (IM) analgesia for patients after surgery <cite>TD2</cite>. | ||
*Patient-controlled analgesia (PCA) allows patients to self-administer small boluses of narcotic, allowing better dose titration, enhanced responsiveness to variability in narcotic requirements, and reduction in serum narcotic level fluctuation <cite>TD3</cite>. | |||
*<cite>TD4</cite> | |||
**OBJECTIVE: To examine and compare the pharmacokinetics and pharmacodynamics of meperidine when administered intramuscularly at gluteal and deltoid sites in elderly postoperative patients. DESIGN: Prospective, randomized investigation. | |||
**SETTING: Tertiary care university teaching hospital. PATIENTS: Fourteen patients 60 years of age or older who were undergoing general surgery. | |||
**INTERVENTION: A single dose of meperidine 0.75 mg/kg given intramuscularly at either a deltoid or gluteal site. | |||
**MAIN OUTCOME MEASURES: Pharmacokinetic (based on concentration-time curves) and pharmacodynamic (i.e., pain scales, need for additional pain medication) comparisons were made, based on site of meperidine injection. | |||
**RESULTS: No statistically significant differences were found in the maximum plasma concentration, volume of distribution, or clearance of meperidine by site of injection. Substantial interpatient variability in pharmacokinetic parameters was noted for both sites (range of maximum concentrations: 191-500 ng/mL gluteal, 166-374 ng/mL deltoid). Although pain scores were similar for the two groups, four of the patients in the group given gluteal injection required additional breakthrough pain management within 4 hours of meperidine injection compared with one patient in the group given deltoid injection. | |||
**CONCLUSIONS: There is no obvious relationship between meperidine pharmacokinetic and pharmacodynamic parameters, regardless of intramuscular injection site. Breakthrough pain is common when patients are given intramuscular injections postoperatively, particularly when the gluteal route is used. When meperidine is used for analgesia in elderly postoperative patients, consideration should be given to more rapid and predictable routes (e.g., intravenous injection) of meperidine administration. | |||
'''Comparing analgesic efficacy of non-steroidal anti-inflammatory drugs given by different routes in acute and chronic pain: a qualitative systematic review'''. DARE. 1998. [http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?View=Full&ID=11998000293 link]. | '''Comparing analgesic efficacy of non-steroidal anti-inflammatory drugs given by different routes in acute and chronic pain: a qualitative systematic review'''. DARE. 1998. [http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?View=Full&ID=11998000293 link]. | ||