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

Tornem a trobar la referència [6].

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 |