Abstract
Objetivo
Comparar la nitroglicerina transdérmica (NTG) con las infiltraciones en las tendinitis del manguito de los rotadores (TMR).
Diseño
Estudio experimental con asignación aleatoria y controlada de individuos.
Emplazamiento
Área básica semirrural, en la comarca del Garraf (Barcelona), con una población asignada de 12.000 habitantes.
Pacientes y métodos
Pacientes diagnosticados de TMR de menos de 6 semanas de evolución que no hubiesen respondido a tratamiento con AINE por vía oral. Los pacientes se distribuyeron aleatoriamente en 2 grupos: a) grupo A: infiltración local por vía posterior con corticoide depot y anestésico local, y b) grupo B: parche de 5 mg de NTG durante 3 días.
Mediciones principales
Se valoraron edad, sexo, dolor (medido con la escala analógica visual) y efectos adversos. Si la respuesta era parcial, se repitió el mismo tratamiento hasta un máximo de 3 veces, con intervalos de 15 días y se realizó un control a los 7–10 días del tratamiento, considerando mejoría total la disminución del dolor más de 5 puntos en la EVA, mejoría parcial la disminución en 3–5 puntos y fracaso si no existía mejoría del dolor o bien disminuía en menos de 3 puntos.
Resultados
Se incluyeron 48 pacientes, 33 mujeres (69%) y 15 varones (31%) con una edad media de 61 años. En el grupo A obtuvieron mejoría total (MT) 19 pacientes, 3 lograron mejoría parcial (MP) y sólo hubo 2 fracasos. En el grupo B presentaron MT 5 pacientes, otros 5 mostraron MP y en 14 fracasó el tratamiento, con diferencias estadísticamente significativas al comparar los 2 grupos. En cuanto a efectos adversos, 4 pacientes del grupo A presentaron dolor leve en la zona de punción y 15 personas del grupo B tuvieron cefalea (8 de los casos abandonaron el tratamiento debido a ello).
Conclusión
El tratamiento con la NTG no es una clara alternativa a las infiltraciones en las TMR, dado que no es un tratamiento más efectivo y, por el contrario, hay un mayor número de pacientes con efectos adversos que deben abandonar el tratamiento.
Palabras clave: Tendinitis manguito rotadores, Infiltración local, Nitroglicerina transdérmica
Abstract
Aims
To compare transdermal nitroglycerin (NTG) and corticosteroid infiltration in patients with rotator cuff tendinitis (RCT).
Design
Experimental, randomized controlled study.
Setting
Semirural basic health area in the Garraf region of Barcelona province, Spain, with a population of public heath service users of 12000.
Patients and methods
Patients diagnosed as having RCT of less than 6 weeks’ evolution who had not responded to treatment with oral nonsteroid antiinflammatory drugs. The patients were distributed randomly into two groups: a) group A, local infiltration via a posterior approach with a depot corticosteroid and local anesthesia, and b) group B, treated for 3 days with a 5-mg NTC patch.
Main measures
Age, sex, pain (measured with an analog visual scale) and adverse events. In patients who showed a partial response, treatment was repeated up to 3 times at 15-day intervals. Pain was tested after 7–10 days of treatment. Complete improvement was considered a reduction in pain of more than 5 points on the analog visual scale; partial improvement was considered a reduction of 3–5 points, and treatment failure was recorded when there was no improvement in pain or when there was a decrease of less than 3 points.
Results
A total of 48 patients were included; 33 (69%) were women and 15 (31%) were men. Mean age was 61 years. In group A, complete improvement was seen in 19 patients and partial improvement in 3; treatment failed in 2 patients. In group B complete improvement was seen in 5 patients, partial improvement in 5, and failure of treatment in 14. The difference between groups was statistically significant. Adverse events were mild pain at the injection site in 4 patients from group A, and headache in 15 patients from group B, 8 of whom abandoned treatment for this reason.
Conclusion
Treatment with NTG is not a clear alternative to infiltration of corticosteroids in patients with RCT, because of its lack of effectiveness and because of the greater number of patients who had adverse events that lead them to abandon treatment.
Key words: Rotator cuff tendonitis, Local infiltration, Transdermal nitroglycerin
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