Manejo multimodal del dolor agudo: papel de los AINES i.v.

Manejo multimodal del dolor agudo: papel de los AINES i.v. Multimodal management of acute Pain: The role of iv NSAIDs R. Sinatra, J. Jahr Anesthesiology News June 2011;1-8. This monograph discusses the concept of multimodal analgesia and preemptive analgesia and presents new data concerning IV nonsteroidal anti-inflammatory drugs and how they can be used to treat acute pain effectively in hospitalized patients http://www.pharmacypracticenews.com/download/SR1124_WM.pdf   Seguridad cardiovascular de las drogas no esteroides antiinflmatorios: Meta-análisis en red Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. Trelle S, Reichenbach S, Wandel S, Hildebrand P, Tschannen B, Villiger PM, Egger M, Jüni P. Institute of Social and Preventive Medicine, University of Bern, Switzerland. BMJ. 2011 Jan 11;342:c7086. doi: 10.1136/bmj.c7086. Abstract OBJECTIVE: To analyse the available evidence on cardiovascular safety of non-steroidal anti-inflammatory drugs. DESIGN: Network meta-analysis. DATA SOURCES: Bibliographic databases, conference proceedings, study registers, the Food and Drug Administration website, reference lists of relevant articles, and reports citing relevant articles through the Science Citation Index (last update July 2009). Manufacturers of celecoxib and lumiracoxib provided additional data. STUDY SELECTION: All large scale randomised controlled trials comparing any non-steroidal anti-inflammatory drug with other non-steroidal anti-inflammatory drugs or placebo. Two investigators independently assessed eligibility. DATA EXTRACTION: The primary outcome was myocardial infarction. Secondary outcomes included stroke, death from cardiovascular disease, and death from any cause. Two investigators independently extracted data. DATA SYNTHESIS: 31 trials in 116,429 patients with more than 115,000 patient years of follow-up were included. Patients were allocated to naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib, lumiracoxib, or placebo. Compared with placebo, rofecoxib was associated with the highest risk of myocardial infarction (rate ratio 2.12, 95% credibility interval 1.26 to 3.56), followed by lumiracoxib (2.00, 0.71 to 6.21). Ibuprofen was associated with the highest risk of stroke (3.36, 1.00 to 11.6), followed by diclofenac (2.86, 1.09 to 8.36). Etoricoxib (4.07, 1.23 to 15.7) and diclofenac (3.98, 1.48 to 12.7) were associated with the highest risk of cardiovascular death. CONCLUSIONS: Although uncertainty remains, little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms. Naproxen seemed least harmful. Cardiovascular risk needs to be taken into account when prescribing any non-steroidal anti-inflammatory drug http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3019238/pdf/bmj.c7086.pdf    Una actualización sobre analgésicos An update on analgesics I. Power Royal Infirmary, University of Edinburgh-Anaesthesia, Critical Care and Pain Medicine, 51 Little France Crescent, Edinburgh EH16 4SA, UK * E-mail: ian.power@ed.ac.uk British Journal of Anaesthesia 107 (1): 19-24 (2011) Recent introduction of new analgesics into the clinic is best described as a slow process with activity classified into two main areas: improving analgesic efficacy/potency and reducing side-effect profile. This review article describes some of the recent advances with an emphasis on use in the acute setting. In this respect, opioids continue to be the mainstay (but not the only) analgesic and there have been important improvements in their clinical effect profile. For example, tapentadol has been introduced as a mixed opioid and norepinephrine uptake inhibitor which, unlike tramadol, does not require metabolic activation and does not suffer from isomer-dependent pharmacodynamics. Opioid antagonists have received much attention recently either used alone, methylnaltrexone (s.c) or alvimopan (p.o), or in combination, Targinact (oxycodone/naloxone), and appear to be effective in reducing opioid side-effects such as those in the gastrointestinal tract. Other agents where there has been recent development include the use of gabapentin, methylxanthines, and local anaesthetics. An interesting area of translation of basic research is in the inhibition of breakdown of endogenous opioids with opiorphin, targeting of the endocannabinoid system, and the use of ampakines to obtund opioid-induced side-effects. It is clear that there is still much work to be done, but the need for highly efficacious analgesics with good side-effect profile remains http://bja.oxfordjournals.org/content/107/1/19.full.pdf+html

Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org