COMPARING ANALGESIC EFFICACY OF NON STEROIDAL ANTIINFLAMMATORY DRUGS GIVEN BY DIFFERENT ROUTES IN ACUTE AND CHRONIC PAIN - A QUALITATIVE SYSTEMATIC REVIEW

Aim: To test the evidence for a difference in analgesic efficacy and a dverse effects of non-steroidal anti-inflammatory drugs (NSAIDs) given by different routes. Methods: Systematic review of published randomis ed controlled trials. Relevant trials were comparisons of the same dru g given by different routes. Presence of internal sensitivity was soug ht as a validity criterion. Analgesic and adverse effect outcomes were summarised, and synthesised qualitatively. Results: In 26 trials (222 5 analysed patients), 8 different NSAIDs were tested in 58 comparisons . Fifteen trials (58%) compared the same drug by different routes. Dru gs were given by intra venous, intramuscular, intrawound, rectal and o ral routes in postoperative pain (14 trials), renal colic (4), acute m usculoskeletal pain (1), dysmenorrhoea (1), and rheumatoid arthritis ( 6). Five of the 15 direct comparisons were invalid because they report ed no difference between routes but without evidence of internal sensi tivity. 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 th e 5 direct comparisons in postoperative pain, results were inconsisten t. In 1 direct comparison in rheumatoid arthritis, intramuscular NSAID was letter than oral. Injected and rectal administration had some spe cific adverse effects. Conclusion: In renal colic there is evidence th at NSAIDs act quickest when given intravenously. This may be clinicall y relevant. In all other pain conditions there is a lack of evidence o f any difference between routes. In pain conditions other than renal c olic, there is, therefore, a strong argument to give oral NSAIDs when patients can swallow. (C) Acta Anaesthesiologica Scandinavica 42 (1998 ).