Comparação de dipirona intravenosa com metoclopramida intravenosa no tratamento de crise aguda de enxaqueca: ensaio clínico randomizado

Abstract

RESUMO -I n t rodução:A enxaqueca é uma das doenças mais comuns da prática clínica. Objetivo: C o m p a r a r o efeito analgésico da dipirona com a metoclopramida no alívio da dor. Método: Conduzimos um estudo piloto randomizado comparando dipirona intravenosa com metoclopramida intravenosa em 27 pacientes apresentando crise de enxaqueca. O objetivo primário foi comparar a redução da intensidade da dor até 2 horas, assim como efeitos colaterais. Resultados: Os grupos tinham faixas etárias semelhantes, mas d i f e rença entre os sexos. Nos homens a metoclopramida reduziu a dor em 80,0% contra 55,0% da dipiro n a (p=0,052). Já nas mulheres houve uma redução de 65,0% com a metoclopramida e 71,2% com a dipirona (p=0,748). Esses resultados podem ter sido influenciados pelo reduzido número de pacientes no estudo. Não foram encontrados efeitos colaterais significativos. Conclusão: Não houve diferença quanto à re d u ç ã o da dor nem quanto ao surgimento de efeitos colaterais quando comparados dipirona com metoclopramida. PALAVRAS-CHAVE: dipirona, metoclopramida, enxaqueca.Comparison of intravenous dipyrone to intravenous metoclopramide in the treatment of acute crisis of migraine: randomized clinical trial ABSTRACT -I n t roduction: Migraine is one of the commonest diseases of clinical practice. Objetive: To c o m p a re the analgesic effect of dipyrone to metoclopramide in the relief of pain. Method: We conducted a pilot randomized study comparing intravenous dipyrone to intravenous metoclopramide in 27 patients presenting acute crisis of migraine. The primary end point was to compare reduction of intensity of pain up to 2 hours, as well as the development of collateral eff e c t s . Results: The groups had similar ages, but t h e re were diff e rence between the sexes. In men, metoclopramide reduced pain in 80.0% compared with 55.0% from dipyrone (p=0.052). In women, there was a reduction of 65.0% with metoclopramide and 71.2% with dipyrone (p=0.748). The small number of patients in the study might have influenced these results. Significant collateral effects were not found. Conclusion: T h e re was no diff e rence about the intensity of pain reduction neither about the development of collateral effects comparing dipyrone to metoclopramide.KEY WORDS: dipyrone, metoclopramide, migraine.A enxaqueca (ou migrânea) é uma cefaléia episódica primária caracterizada por alterações neuro l ó-gicas, autonômicas e gastrointestinais em variadas c o m b i n a ç õ e s 1 . Está também entre as doenças menos diagnosticadas e, logo, inadequadamente tratadas da prática clínica, com a maioria dos pacientes nunca tendo procurado um médico ou ter desistido do m e s m o 2 . É, entretanto, uma moléstia comum, acometendo com pelo menos um ataque de migrânea por ano, 6% dos homens e 18% das mulheres nos Estados Unidos e até 22% dos brasileiro s 1 , 3 . Além disso, um dia com migrânea grave tem a classificação máxima da escala de incapacidade neurológica da OMS, sendo equivalente à quadriplegia, demência ou psicose a t i v a 4 . Apesar diss...

The effectiveness of parenteral agents for pain reduction in patients with migraine presenting to emergency settings: A systematic review and network analysis

“…Nearly half of the included studies were conducted in the USA, 10,11,40–76 followed in frequency by Iran, 9,77–87 Turkey, 88–99 Brazil, 35–39,100,101 Canada, 102–107 Germany, 108–112 Australia, 113–117 Spain, 118,119 Mexico, 120,121 Sweden, 122 Finland, 123 and New Zealand 124 . Five studies enrolled patients from multiple international sites 125–129 .…”

“…A total of 25 studies assessed metoclopramide 9,11,46,48,49,53,55–57,59,60,74,77,79,80,85,86,93–95,100,119–121,130 which was most commonly provided as a single 10 mg intravenous (IV) dose. Most of the studies administered metoclopramide as monotherapy; however, three studies provided an adjunct therapy consisting of either diphenhydramine, 55 dexamethasone, 85 or propofol 77 .…”

“…A total of 24 studies provided patients with NSAIDs 36,50,51,57,63,65,70,71,79,89–91,93,97–101,109–112,125,131 . Ketorolac was the most‐studied NSAID agent, which was administered as a single 30 mg IV dose 57,70,79 or a single intramuscular injection of 30 65 or 60 mg 50,51,63,71 .…”

“…The remaining studies most frequently utilized a 4-point verbal rating scale (i.e., 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain) [35][36][37][38][39]41,42,44,52,62,63,66,68,72,75,96,97,101,106,108,109,118,[120][121][122]124,[126][127][128][129] or a 10-or 11-point numeric rating scale. 10,11,40,45,[55][56][57][58]84,85,89,92,100,102,106,115,116,130 Six studies measured pain using other scales including the Borg scale, 50 an unspecified 1-5 point Likert scale, 69 a 0-4 poi...…”

“…110 Non-steroidal anti-inflammatory drugs A total of 24 studies provided patients with NSA IDs. 36,50,51,57,63,65,70,71,79,[89][90][91]93,[97][98][99][100][101][109][110][111][112]125,131 Ketorolac was the most-studied NSAID agent, which was administered as a single 30 mg IV dose 57,70,79 or a single intramuscular injection of 30 65 or 60 mg. 50,51,63,71 Other studies provided patients with dexketoprofen, 90,91,93,98,99 lysine-acetylsalicylic acid, 109,110,112,125 diclofenac, 36,97,131 ibuprofen, 53,89,91 dipyrone, 100 parecoxib, 111 or lysine clonixidate.…”