Evidència científica del tractament farmacològic del dolor postoperaori en cirurgia ortopèdica i/o traumatològica i de lespasticitat per malaltia neurològica no progressiva
Two systematic review have been done about two very usual symptoms treated in the Traumatology and Rehabilitation area. Those symptoms are the postoperative pain after traumatic and orthopaedic surgery (TOS), and the spasticity in patients with non-progressive neurological disease.
-Systematic review of analgesic drugs in the treatment of the postoperative pain after TOS
Objective: To assess analgesic drugs in the treatment of postoperative pain after TOS.
Design: Systematic review of randomised clinical trials (RCTs).
Data sources: Electronic PubMed, EMBASE, The Cochrane Library, and hand searches.
Study selection: RCTs of analgesics administered by oral, intramuscular, intravenous, subcutaneous or rectal route, compared to other analgesics or placebo, in patients under TOS. Study design, characteristics of the study population, analgesic drugs tested, pain intensity and pain relief scores, and adverse effects were assessed.
Results: 92 RCTs (9,596 patients) met our inclusion criteria. Forty-two (46%) were placebo-controlled, and 50 (54%) were direct comparisons between non-opioid, opioid, and/or combinations of both. Patients mean age (SD) was 49 years (18). In most trials, gastrointestinal ulcer, liver and renal diseases were exclusion criteria. Only 30 trials (33%) were double-blind and reported standardised outcomes of pain intensity and pain relief; 19 of these were single-dose, and follow up of analgesic effects lasted no more than 12 hours in 23 (77%). Globally, only nine trials (10%) were double blind, described dropouts or withdrawals, performed analysis by intention to treat, and reported the effects magnitude.
Conclusion: Evidence from RCTs on the treatment of postoperative pain after TOS is inadequate for clinical decision making. Assessment of analgesics in pain after TOS should be based on agreed clinically relevant outcomes, in representative patients, and for longer observation periods. In addition, it should include direct comparisons between candidate drugs or their combinations and between various drug administration schedules.
-Systematic review of oral antispastic drugs in the treatment of spasticity in patients with non-progressive neurological disease.
Objective: To assess the efficacy of oral drugs in the treatment of spasticity in patients with non-progressive neurological disease (NPND).
Design: Systematic review of double-blind randomised controlled trials.
Data sources: electronic MEDLINE, PubMed, Cochrane Library and hand searches.
Results: Twelve studies (469 patients) were included (6 on stroke, 3 on spinal cord diseases, and 3 on cerebral palsy). Tizanidine was assessed in four trials (276 patients, 142 exposed), dantrolene in four (103, 93), baclofen in three (70, 55), diazepam in two (127, 76), and gabapentin in one (28, all exposed). Most trials were of small size, of short duration and their methodological quality was inadequate. Ten trials were controlled with placebo and only two were direct comparisons between drugs. Efficacy outcome variables were heterogeneous. Only four reports described the magnitude of the anti-spastic effect. The incidence of adverse drug effects (drowsiness, sedation and muscle weakness) was high.
Conclusion: Evidence on the efficacy of oral anti-spastic drugs in NPND is weak and does not include evaluation of patients quality of life. If any, efficacy is marginal. Adverse drug reactions were common. Better methodological instruments are needed for the evaluation of anti-spastic treatment.
Advisor:Vallano Ferraz, Antoni
School:Universitat Autónoma de Barcelona
Source Type:Master's Thesis
Keywords:449 departament de farmacologia i terapeutica
Date of Publication:12/17/2007