Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2004
ReviewHypotonic vs isotonic saline solutions for intravenous fluid management of acute infections.
Hypotonic saline is commonly used as maintenance fluid in the management of acute infections. In recent years use of a hypotonic saline has been associated with adverse outcomes. To reduce the rates of adverse outcomes, use of isotonic saline as maintenance fluid has been suggested. ⋯ We found no randomised controlled evidence to show that use of isotonic saline as a maintenance fluid instead of a hypotonic saline will lead to an improvement in outcomes. Randomised trials with adequate design and sample sizes are needed to evaluate the possible advantages and risks of using isotonic saline as maintenance fluid.
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Methadone is an opioid used in the management of cancer pain both in opioid naïve patients and in rotation from other opioids. A particular role in neuropathic pain has been suggested. The quest for evidence based palliative care prompted a formal appraisal of methadone in comparison with other analgesics. ⋯ There is evidence to suggest that methadone is an analgesic with similar efficacy to morphine and a comparable side effect profile. However, the majority of studies involved single dose comparisons or short term use. This methodology fails to reproduce clinical practice. Therefore there is a very significant danger that the effects of methadone accumulation leading to delayed onset of adverse effects which occurs with chronic administration has not been represented. Fixed interval dosing schedules conducted over several days are associated with a high risk of serious morbidity and mortality. There is no trial evidence to support the proposal that methadone has a particular role in neuropathic pain of malignant origin. Conclusions have been limited by the variations in trial design, dosing regimens and limited presentation of primary outcome data. The complex and highly individual pharmacokinetics of methadone require that experienced clinicians take responsibility for initiating, titrating and monitoring this drug.
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Cochrane Db Syst Rev · Jan 2004
ReviewMobile bearing vs fixed bearing prostheses for total knee arthroplasty for post-operative functional status in patients with osteoarthritis and rheumatoid arthritis.
The polyethylene insert in a total knee replacement (TKR) can be fixed to the tibial plateau or it can have freedom of rotation and / or translation. It is not yet clear whether there are differences in functional or clinical results between the two prosthesis types. ⋯ We could find no evidence of superiority for one of the two prosthesis types with regard to ROM or functional performance of the patients. The majority (96%) of patients in the 2 included studies had OA. Therefore, the results reflect primarily results in OA patients.
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Cochrane Db Syst Rev · Jan 2004
Review Meta AnalysisPalliation of metastatic bone pain: single fraction versus multifraction radiotherapy - a systematic review of the randomised trials.
Recent randomised studies reported that single fraction radiotherapy was as effective as multifraction radiotherapy in relieving pain due to bone metastasis. However, there are concerns about the higher re-treatment rates and the efficacy of preventing future complications such as pathological fracture and spinal cord compression by single fraction radiotherapy. ⋯ Single fraction radiotherapy was as effective as multifraction radiotherapy in relieving metastatic bone pain. However, the re-treatment rate and pathological fracture rates were higher after single fraction radiotherapy. Studies with quality of life and health economic end points are warranted to find out the optimal treatment option.
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Diclofenac is a benzene-acetic acid derivative that acts, like other NSAIDs, by inhibiting cyclo-oxygenase isoforms that mediate the body's production of the prostaglandins implicated in pain and inflammation. Diclofenac is widely available as a sodium or potassium salt. Diclofenac potassium tablets are known as 'immediate-release' diclofenac as absorption takes place in the gastrointestinal tract whereas 'delayed-release' (enteric-coated) diclofenac tablets resist dissolution until reaching the duodenum. An existing review showed that diclofenac was an effective treatment for acute postoperative pain but did not address the distinction between potassium and sodium salts due to lack of data. The aim of this update is to gather and add appropriate information published subsequently and, data permitting, examine any potential differences between the two different diclofenac formulations. ⋯ Oral diclofenac is an effective single-dose treatment for moderate to severe postoperative pain. There was no significant difference between diclofenac and placebo in the incidence of adverse effects, or between diclofenac sodium and potassium, different pain models, smaller and larger trials and trials of higher and lower quality.