British Journal of Anaesthesia, Vol 84, Issue 1 48-58, Copyright © 2000 by Oxford University Press
LA Smith, D Carroll, JE Edwards, RA Moore and HJ McQuay
For a systematic review of postoperative analgesic efficacy and adverse
effects of single doses, injected or oral, of pethidine and ketorolac
compared with placebo, we sought published randomized studies in moderate
to severe postoperative pain. Information on summed pain intensity or pain
relief outcomes over 4-6 h was extracted and converted to dichotomous
information to produce the number of patients with at least 50% pain
relief. This was used to calculate the relative benefit and
number-needed-to-treat (NNT) for one patient to achieve at least 50% pain
relief. Minor and major adverse effect data were extracted and summarized.
For pethidine 100 mg i.m., eight randomized, controlled studies met the
inclusion criteria, with 203 patients given pethidine and 161 placebo. The
NNT to produce at least 50% pain relief was 2.9 (95% confidence interval
2.3-3.9). At this dose, pethidine produced significantly more drowsiness
and dizziness than placebo, with numbers-needed-to-harm (NNH) of 2.9
(2.2-4.4) and 7.2 (4.8-14), respectively. For ketorolac, 14 reports met the
inclusion criteria (six i.m. and eight oral). Most i.m. information (176
patients) was available for the 30 mg dose, which had an NNT of 3.4
(2.5-4.9). Most oral information was available for the 10 mg dose, which
had an NNT of 2.6 (2.3-3.1). Oral ketorolac 10 mg was consistently at least
as effective as ketorolac 30 mg i.m. Only with oral ketorolac 10 mg were
there significantly more adverse effects than with placebo, with an NNH for
any adverse effect of 7.3 (4.7-17).
ARTICLES
Single-dose ketorolac and pethidine in acute postoperative pain: systematic review with meta-analysis
Nuffield Department of Anaesthetics, University of Oxford, Oxford Radcliffe Hospital, Headington, UK.
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