EBM 期刊討論 (1) - Buscopan 對腎結石痛有效嗎?

@ 2012-0112 摘要

臨床情境：63y/o female, urolithiasis history, CC: Lower abdominal pain for 2 hours, UR: hematuria (OB 2+)& pyuria, KUB: no visible stone, Abd sono: mild hydronephrosis, R’t

臨床問題：
Is buscopan effective in patient with renal colic?

PICO:
P: Renal colic, adult
I: Buscopan
C: placebo
O: pain relief, stone passage

問題類型：治療/預防

資料庫資源：Cochrane Library

Search Term: Buscopan  AND  renal colic
找到兩篇，第一篇即符合需求。
Is there a role for antimuscarinics in renal colic? A randomized controlled trial. The J of Urology. 2005;174:572–575.

研究設計：RCT

文獻評讀：
有效性：

    RCT, N = 192, n = 178 for analysis, 作者自稱ITT，詳看內文並不是！
    Buscopan: 85 / 91 = 93.4%, Placebo: 93 / 101 = 92.1%

    Double Blind (p’t got sequentially numbered opaque sealed envelopes / Administration of the study drug or placebo was by the treating doctor without the knowledge of the patient or nursing staff.)

重要性：

    Buscopan group required a median of 0.12 mg/kg of morphine while those in the placebo group received a median of 0.11 mg/kg, no significant difference (p = 0.4).

    Required additional morphine, 33% in the Buscopan group and 38% in the placebo group (p = 0.5).

證據等級（1a~5）：1b

文獻主要結論：

There is no evidence that Buscopan reduces opioid requirements or the need for ongoing opioid analgesia in acute renal colic.

建議等級（A~D）：A

評論及應用至你的病人：

    Uptodate: renal colic pain control => NSAID and opioid，Buscopan 沒有角色 (連提都沒提：)

    研究結果為 Buscopan  對疼痛緩解無效，對 Opioid 副作用（噁心嘔吐）也無助益，徒增醫療花費。

    文章限制：收案對象為 pain severe enough to require parenteral analgesia, findings are not necessarily applicable to patients with milder pain.

搜尋日期：2012/1/9；預計再搜尋日期：2014/1/9

報告者：陳○○

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