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MBE: AINE IM vs VO (mostra el codi font)

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[http://clinicalevidence.bmj.com/ceweb/index.jsp Clinical Evidence], només accés des de l'ICS.
[http://clinicalevidence.bmj.com/ceweb/index.jsp Clinical Evidence], només accés des de l'ICS.
Cerca: ''pain''.


No hi ha res.
No hi ha res.
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dolor AINE intramuscular oral
dolor AINE intramuscular oral


'''GPC. Manejo del dolor agudo en atención primaria'''.
'''Guía de Práctica Clínica sobre Lumbalgia'''.
Guíasalud - 2007.
Guíasalud - 2007.
(Unidad del dolor – Hospital Xeral - Calde – Lugo). [http://www.guiasalud.es/GPC/GPC_368_Dolor_AP.pdf link]
[http://www.osanet.euskadi.net/r85-20341/es/contenidos/informacion/publicaciones_osk/es_6574/adjuntos/guia_lumbalgia_c.pdf link]


   En cuanto a la vía de administración de los AINE, la revisión Cochrane <cite>EC1</cite> sugiere que
   En cuanto a la vía de administración de los AINE, la revisión Cochrane <cite>EC1</cite> sugiere que
Línia 65: Línia 67:


   In renal colic there was evidence that NSAIDs act quickest when given intravenously.  
   In renal colic there was evidence that NSAIDs act quickest when given intravenously.  
   In all other pain conditions there was a lack of evidence of any difference between administration routes.  
   In all other pain conditions there was a lack of evidence  
  of any difference between administration routes.  
   In pain conditions other than renal colic, there is, therefore,  
   In pain conditions other than renal colic, there is, therefore,  
   a strong argument to give oral NSAIDs when patients can swallow <cite>TD5</cite>.
   a strong argument to give oral NSAIDs when patients can swallow <cite>TD5</cite>.


*OBJECTIVE: To compare the clinical efficacy of single doses of intramuscular ketorolac and oral ibuprofen in the emergency department (ED) treatment of acute pain.  
*AIM: To test the evidence for a difference in analgesic efficacy and adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs) given by different routes.  
*DESIGN: A retrospective analysis of data collected during a prospective survey of pain management efficacy. The design was noninterventional, and therapy was selected by the treating physician independent of the trial.  
*METHODS: Systematic review of published randomised controlled trials. Relevant trials were comparisons of the same drug given by different routes. Presence of internal sensitivity was sought as a validity criterion. Analgesic and adverse effect outcomes were summarised, and synthesised qualitatively.  
*SETTING: Urban teaching hospital adult patient emergency department.
*RESULTS: In 26 trials (2225 analysed patients), 8 different NSAIDs were tested in 58 comparisons. Fifteen trials (58%) compared the same drug by different routes. Drugs were given by intravenous, intramuscular, intrawound, rectal and oral routes in postoperative pain (14 trials), renal colic (4), acute musculoskeletal pain (1), dysmenorrhoea (1), and rheumatoid arthritis (6). Five of the 15 direct comparisons were invalid because they reported no difference between routes but without evidence of internal sensitivity. In all 3 direct comparisons in renal colic, intravenous NSAID had a faster onset of action than intramuscular or rectal. In 1 direct comparison in dysmenorrhoea, oral NSAID was better than rectal. In the 5 direct comparisons in postoperative pain, results were inconsistent. In 1 direct comparison in rheumatoid arthritis, intramuscular NSAID was better than oral. Injected and rectal administration had some specific adverse effects.  
*PARTICIPANTS: A convenience sample of ED patients in acute pain.  
*CONCLUSION: In renal colic there is evidence that NSAIDs act quickest when given intravenously. This may be clinically relevant. In all other pain conditions there is a lack of evidence of any difference between routes. In pain conditions other than renal colic, there is, therefore, a strong argument to give oral NSAIDs when patients can swallow.
*INTERVENTIONS: Patients received ibuprofen 800 mg po (n = 95), or ketorolac 60 mg im (n = 30) as a single dose. Therapy was selected by the treating physician and was not influenced by the study.  
*RESULTS: Data collected were a 100-mm visual analog pain scale at patient arrival and discharge, verbal description of pain relief, patient demographics, pain management data, and discharge diagnosis. Baseline pain intensity was higher in patients receiving ketorolac (77 mm median) than in those receiving ibuprofen (65 mm, p = 0.02). Pain relief was similar (p = 0.29) with either treatment when assessed by visual analog scale or patient definition of pain relief. CONCLUSIONS: A single dose of either nonsteroidal antiinflammatory drug produced similar pain relief in the general ED population during clinical treatment of pain. Ketorolac should not necessarily be considered a more effective analgesic than ibuprofen in these commonly used doses.


==Cochrane==
==Cochrane==
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*pain and NSAID and intramuscular and oral
*pain and NSAID and intramuscular and oral


   In renal colic there is evidence that NSAIDs actquickest when given intravenously. This may be clinically relevant.  
   In renal colic there is evidence that NSAIDs actquickest when given intravenously.  
  This may be clinically relevant.  
   In all other pain conditions there is a lack of evidence of any difference between routes.  
   In all other pain conditions there is a lack of evidence of any difference between routes.  
   In pain conditions other than renal colic, there is, therefore, a strong argument to give oral NSAIDs when patients can swallow <cite>TD5</cite>.  
   In pain conditions other than renal colic, there is, therefore,  
  a strong argument to give oral NSAIDs when patients can swallow <cite>TD5</cite>.  
    
    
La mateixa que en el TripDatabase.
La mateixa que en el TripDatabase.
Línia 100: Línia 103:
   Administration, Oral
   Administration, Oral


#Aquesta <cite>PM2</cite>:
##OBJECTIVE: There is a commonly held belief among health care providers that patients respond better to parenteral nonsteroidal anti-inflammatory drugs (NSAIDs) than to oral forms by virtue of the patients' belief that getting an injection means they are receiving "stronger" medicine. To the authors' knowledge, this effect has never been adequately documented in the literature. The objective of this study was to compare the effects of a placebo analgesic injection vs placebo oral analgesia on patients with acute musculoskeletal pain.
##METHODS: A convenience sample of emergency department (ED) patients with acute musculoskeletal pain secondary to trauma were enrolled. Patients received 225 mL of orange-flavored drink containing 800 mg of ibuprofen. Patients then received either a physiologically inactive starch tablet resembling ibuprofen 800 mg in taste and appearance or a physiologically inactive saline intramuscular (IM) injection resembling ketorolac 60 mg. Both patients and research nurses were blinded to the addition of ibuprofen to the drink and the inactive nature of subsequent medication. Pain was evaluated at time 0 and at 30, 60, 90, and 120 minutes on a 10-mm visual analog scale (VAS).
##RESULTS: Sixty-four patients completed the study protocol. The VAS scores between groups did not differ significantly at baseline or at each subsequent interval (p = 0.86).
##CONCLUSIONS: These results contradict the belief that parenteral medications confer a selective placebo effect stemming from patients' beliefs regarding route of administration and efficacy. Therefore, the routine use of IM administration of NSAIDs for suspected enhanced analgesia appears unwarranted.
#Tornem a trobar la referència <cite>TD5</cite>.
#Tornem a trobar la referència <cite>TD5</cite>.
#I aquesta <cite>PM1</cite>:
#I aquesta <cite>PM1</cite>:
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*<cite>TD4</cite>: estudi randomitzat. N=14. Les injeccions intramusculars tenen una absorció erràtica mirant les concentracions del fàrmac en sang.
*<cite>TD4</cite>: estudi randomitzat. N=14. Les injeccions intramusculars tenen una absorció erràtica mirant les concentracions del fàrmac en sang.
*<cite>TD5</cite>: '''revisió sistemàtica d'assajos clínics. N=2225. Excepte en el còlic nefrític no hi ha evidència que cap de les rutes sigui millor que la oral'''.  
*<cite>TD5</cite>: '''revisió sistemàtica d'assajos clínics. N=2225. Excepte en el còlic nefrític no hi ha evidència que cap de les rutes sigui millor que la oral'''.  
*<cite>PM2</cite>: '''assaig clínic a doble cec. N=64. No hi havien diferències entre els 2 grups'''.
*<cite>PM1</cite>: anàlisi retrospactiu. N=?. El ketorolak IM no ha demostrat ser millor que l'ibuprofè VO.
*<cite>PM1</cite>: anàlisi retrospactiu. N=?. El ketorolak IM no ha demostrat ser millor que l'ibuprofè VO.


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#TD5 pmid=9527748  
#TD5 pmid=9527748  
#PM1 pmid=8193414  
#PM1 pmid=8193414  
#PM2 pmid=10958124
</biblio>
</biblio>
Obtingut de «http://traba.org:8080/Especial:MobileDiff/15452...17525»