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1. Oral tenocixam reduced the number of compressions required for treatment of DCI in recreational divers, but had no impact on overall outcome. |
Citation:
1. Bennett M, Mitchell S, Dominguez A. Adjunctive treatment of decompression
illness with a non-steroidal anti-inflammatory drug (Tenoxicam) reduces
compression requirements. Undersea and Hyperbaric Medicine 2003; 30(3):195-204.
Lead author's name and fax: M. Bennett m.bennett@unsw.edu.au
Three-part Clinical Question: In recreational divers with DCI, would
addition of oral tenoxicam to standard compression therapy improve outcome
and/or reduce number of compressions required?
Search Terms: Decompression illness, non-steroidal anti-inflammatory
drug, tenoxicam
The Study:
Double-blinded concealed randomised controlled trial with intention-to-treat.
The Study Patients: Adult divers presenting for treatment of DCI and
where the clinical diagnosis was not cerebral arterial gas embolism (CAGE).
Control group (N = 90; 80 analysed): Initial compression schedule by
physician choice, including USN TT6, USN TT5 and 2.4ATA 90 min O2 table.
Follow-up treatments either 2.4 ATA 90 minute O2 table or 1.9 ATA 120 minute O2
table until cure or plateau. Placebo given at initial treatment during first air
break and for total of 7 daily doses.
Experimental group (N = 90; 84 analysed): As above but tenoxicam given at
initial treatment during first air break and for total of 7 daily doses.
The Evidence:
|
Outcome |
Time to
Outcome |
Control
group |
Tenoxicam
group |
Relative
risk reduction |
Absolute
risk reduction |
NNT |
|
Proportion
not completely well |
discharge |
0.28 |
0.34 |
-24% |
-0.07 |
-15 |
|
95%
Confidence Intervals: |
-72%
to 25% |
-0.20
to 0.07 |
NNT
= 15 to INF NNH = 5 to INF |
|||
|
Proportion
not completely well |
4
to 6 weeks |
0.18 |
0.16 |
12% |
0.02 |
45 |
|
95%
Confidence Intervals: |
-49%
to 74% |
-0.09
to 0.13 |
NNT
= 8 to INF; NNH = 12 to INF |
|||
|
Non-Event
Outcomes |
Time to
outcome/s |
Control
group |
Tenoxicam group |
P-value |
|
Median
number of treatments required |
discharge |
3 |
2 |
0.01 |
Comments:
1. Patient compliance depended on self-administration and self-reporting.
Possible that this would underestimate the efficacy of tenoxicam, however, this
reflects clinical practice.
2. At the time of discharge 9% of patients had an different diagnosis
(musculoskeletal injury, respiratory tract infection, ear barotrauma and CAGE).
?possibility that results reflect efficacy of tenoxicam on non-DCI injury.
3. Tenoxicam's treatment sparing effect occurred at all grades of severity.
4. Can't exclude possibility that tenoxicam reduced pain and as a consequence
reduced number of compressions were due to this effect. No evidence this
affected outcome at six weeks.
Appraised by: S. Singham, Prince of Wales Hospital, Sydney; Thursday, 23
December 2004
Email: s_singham@yahoo.com
Kill or Update By: January 2006