MBE: AINE IM vs VO

La pregunta

La via intramuscular és millor que la via oral a l'hora de tractar un dolor agut?

Com formular la pregunta

• P-> Problema: dolor agut
• I-> Intervenció: AINE VO
• C-> Control: AINE IM
• O-> Output (Resultat): millora del dolor subjectiva (EVA)

Cerca

TripDatabase

TripDatabase en Español

dolor AINE intramuscular oral

GPC. Manejo del dolor agudo en atención primaria. Guíasalud - 2007. (Unidad del dolor – Hospital Xeral - Calde – Lugo)

 En cuanto a la vía de administración de los AINE, la revisión Cochrane [1] sugiere que
 no hay evidencia para recomendar otra vía que no sea la oral en la lumbalgia aguda.

TripDatabase

pain NSAID intramuscular oral

Acute pain management in older adults. National Guideline Clearinghouse (USA). 2006.

 Avoid intramuscular (IM) administration in older adults. 
 Because of muscle wasting and less fatty tissue in older as compared to younger adults, 
 intramuscular absorption of analgesics in older adults is slowed 
 and may result in delayed/prolonged effect of IM injections, 
 altered analgesic serum levels and possible toxicity with repeated injections [2, 3, 4, 5]. 
 Evidence Grade = B

Comparing analgesic efficacy of non-steroidal anti-inflammatory drugs given by different routes in acute and chronic pain: a qualitative systematic review. DARE. 1998. link.

 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 pain conditions other than renal colic, there is, therefore, 
 a strong argument to give oral NSAIDs when patients can swallow [6].

Cochrane, revisions sistemàtiques

• dolor and AINE 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 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 [6]. La mateixa que en el TripDatabase.

PubMed

Paraules MeSH utilitzades

 Pain
 Anti-Inflammatory Agents, Non-Steroidal
 Injections, Intramuscular
 Administration, Oral

1. Tornem a trobar la referència [6].
2. I aquesta [7]:
   1. OBJECTIVE: To compare the clinical efficacy of single doses of intramuscular ketorolac and oral ibuprofen in the emergency department (ED) treatment of acute pain.
   2. 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.
   3. SETTING: Urban teaching hospital adult patient emergency department.
   4. PARTICIPANTS: A convenience sample of ED patients in acute pain.
   5. 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.
   6. 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.
   7. 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.

Bibliografia

1. van Tulder MW, Scholten RJ, Koes BW, and Deyo RA. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev. 2000(2):CD000396. DOI:10.1002/14651858.CD000396 |
2. Austin KL, Stapleton JV, and Mather LE. Multiple intramuscular injections: a major source of variability in analgesic response to meperidine. Pain. 1980 Feb;8(1):47-62. DOI:10.1016/0304-3959(80)90089-5 |
3. Conner M and Deane D. Patterns of patient-controlled analgesia and intramuscular analgesia. Appl Nurs Res. 1995 May;8(2):67-72. DOI:10.1016/s0897-1897(95)80502-8 |
4. Egbert AM, Parks LH, Short LM, and Burnett ML. Randomized trial of postoperative patient-controlled analgesia vs intramuscular narcotics in frail elderly men. Arch Intern Med. 1990 Sep;150(9):1897-903.
5. Erstad BL, Meeks ML, Chow HH, Rappaport WD, and Levinson ML. Site-specific pharmacokinetics and pharmacodynamics of intramuscular meperidine in elderly postoperative patients. Ann Pharmacother. 1997 Jan;31(1):23-8. DOI:10.1177/106002809703100102 |
6. Tramèr MR, Williams JE, Carroll D, Wiffen PJ, Moore RA, and McQuay HJ. Comparing analgesic efficacy of non-steroidal anti-inflammatory drugs given by different routes in acute and chronic pain: a qualitative systematic review. Acta Anaesthesiol Scand. 1998 Jan;42(1):71-9. DOI:10.1111/j.1399-6576.1998.tb05083.x |
7. Wright JM, Price SD, and Watson WA. NSAID use and efficacy in the emergency department: single doses of oral ibuprofen versus intramuscular ketorolac. Ann Pharmacother. 1994 Mar;28(3):309-12. DOI:10.1177/106002809402800301 |