Tenoxicam reduced the number of compressions required to treat DCI
Clinical Bottom Line:
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 2004Email: s_singham@yahoo.com
Kill or Update By: January 2006



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