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Evidence summaries

Different Routes of Administration of Non-Steroidal Anti-Inflammatory Drugs

In renal colic NSAIDs appear to act quickest when given intravenously. In all other pain conditions there is a lack of evidence of any difference between routes. Level of evidence: "B"

A systematic review 1 including 26 RCTs with a total of 2 225 subjects was abstracted in DARE. In the 5 direct comparisons in post-operative pain, results were inconsistent. 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 the 1 direct comparison in rheumatoid arthritis, intramuscular NSAID was better than oral. Adverse effects related to the route of administration were most often reported for intramuscular and rectal regimens.

Comment: The quality of evidence is downgraded by sparse data. The authors conclude that in pain conditions other than renal colic, there is a strong argument to give oral NSAIDs when patients can swallow.

References

  • Tramèr MR, Williams JE, Carroll D, Wiffen PJ, Moore RA, 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. [PubMed] [DARE]

Primary/Secondary Keywords