Page 186 Acute Pain Management

There was a small but significant reduction of pain with the use of topical NSAIDs for traumatic
corneal abrasions (Calder et al, 2005 Level I).
Use of topical ketoprofen patches showed mild clinical benefit over placebo in tendinitis and
ankle sprain (NNT 5 to 6) (Mazieres, Rouanet, Guillon et al, 2005 Level II; Mazieres, Rouanet, Velicy et
al, 2005 Level II).
Topical NSAIDs were of limited efficacy in lateral elbow pain providing short‐term functional
improvement for up to 2 weeks. They resulted in fewer GI side effects compared with oral
NSAIDs (Green et al, 2001 Level I).
Overall, there are insufficient data to support the use of topical NSAID analgesia in acute and
chronic Achilles tendinitis (McLauchlan & Handoll, 2001 Level I) or in superficial venous
thrombosis of the leg (Di Nisio et al, 2007 Level I).
There is insufficient evident to differentiate between routes of administration of NSAIDs in the
treatment of low back pain (Roelofs et al, 2008 Level I).

Key messages
1. Topical NSAIDs are of limited efficacy in lateral elbow pain and provide short‐term
functional improvement; they result in fewer gastrointestinal side effects compared with
oral NSAIDs (N) (Level I [Cochrane Review]).
2. Non‐selective NSAIDs added to local anaesthetic solutions for IVRA improve postoperative
analgesia (N) (Level I).
CHAPTER 5 3. Topical NSAIDs are effective in treating acute strains, sprains or sports injuries for up to
1 week with ketoprofen being significantly better than all other topical NSAIDs, and
indomethacin similar to placebo (N) (Level I).
4. Topical diclofenac significantly reduces pain and inflammation in a range of sports,
traumatic and inflammatory conditions and in acute musculoskeletal injuries is at least
comparable to oral naproxen (N) (Level I).
5. Topical NSAIDs are effective analgesics for traumatic corneal abrasions (N) (Level I).

REFERENCES

AAGBI (2007) Management of Local Anaesthetic Toxicity.
http://www.aagbi.org/publications/guidelines/docs/latoxicity07.pdf Association of Anaesthetists of
Great Britain and Ireland. Accessed May 2009.
Abrahams MS, Panzer O, Atchabahian A et al (2008) Case report: limitation of local anesthetic spread
during ultrasound‐guided interscalene block. Description of an anatomic variant with clinical correlation.
Reg Anesth Pain Med 33(4): 357–9.
Al‐Metwalli RR, Mowafi HA, Ismail SA et al (2008) Effect of intra‐articular dexmedetomidine on
postoperative analgesia after arthroscopic knee surgery. Br J Anaesth 101(3): 395–9.
Alagol A, Calpur OU, Usar PS et al (2005) Intraarticular analgesia after arthroscopic knee surgery:
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Traumatol Arthrosc 13(8): 658–63.
Andrieu G, Roth B, Ousmane L et al (2009) The efficacy of intrathecal morphine with or without clonidine
for postoperative analgesia after radical prostatectomy. Anesth Analg 108(6): 1954–7.
Ansermino M, Basu R, Vandebeek C et al (2003) Nonopioid additives to local anaesthetics for caudal
blockade in children: a systematic review. Paediatr Anaesth 13(7): 561–73.

138 Acute Pain Management: Scientific Evidence