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Three Part Question

In [emergency department patients with dysmenorrhoea] are [Salbutamol preparation, beta adrenoreceptor agonists effective] in [improving pain].

Clinical Scenario

A 32 year old woman presents to the emergency department complaining of lower abdominal pain associated with bleeding. She has a history of bad period pain for which she takes medication. She has taken all her normal oral medication and is still in pain. You are familiar with salbutamol and it’s action on smooth muscle and know that it is used for tocolysis; you wonder if they may help her pain.

Search Strategy

Databases searched:

o Evidence Based Reviews: The Cochrane Library

o Guidance: NICE Guidance, WHO

o Healthcare Databases: MEDLINE, Embase

o Specialist Website: NHS Evidence, Pubmed

o Google scholar
Search History:

1. Medline; exp ALBUTEROL/; 8813 results.

2. Medline; exp TERBUTALINE/; 2966 results.

3. Medline; exp EPHEDRINE/; 4416 results.

4. Medline; exp ISOPROTERENOL/; 28796 results.

5. Medline; exp DOBUTAMINE/; 5692 results.

6. Medline; exp XAMOTEROL/; 252 results.

7. Medline; exp METAPROTERENOL/; 3157 results.

8. Medline; exp CLENBUTEROL/; 1234 results.

9. Medline; exp RITODRINE/; 917 results.

10. Medline; (bambuterol OR formoterol OR indacaterol OR olodaterol OR salmeterol OR amibegron OR mirabegron OR solabegron OR denopamine OR bitolterol OR levosalbutamol OR ventolin OR ventmax OR salbutamol OR asmasal OR airomir OR "air salb" OR salpin OR salamol).ti,ab; 9725 results.

11. Medline; exp DYSMENORRHEA/; 3186 results.

12. Medline; (dysmenorrhoea OR "period pain" OR period AND pain OR "menstrual pain" OR menstrual AND pain OR painful AND menstruation OR "painful menstruation").ti,ab; 42026 results.

13. Medline; 1 OR 2 OR 3 OR 4 OR 5 OR 6 OR 7 OR 8 OR 9 OR 10; 56778 results.

14. Medline; 11 OR 12; 44357 results.

15. Medline; 13 AND 14; 43 results.

16. Medline; 15 [Limit to: (Language English) and Humans and Females]; 31 results.

Search Outcome

1 paper was identified that was relevant to the clinical question and there was 1 Cochrane review. Salbutamol has never been studied.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses

Comment(s)

There is evidence that beta-adrenoreceptor agonists reduce uterine tonicity, but insufficient evidence that this translates to the reduction of pain. The study available on inhaled beta 2 agonist is too small to make an adequate assessment of their utility. The limited evidence there shows that this is potential treatment worthy of further study.

Clinical Bottom Line

There is no evidence currently to suggest that Salbutamol as beta-adrenoreceptor agonists are effective as pain relief for dysmenorrhoea and further study is required. However there are studies on other beta adrenoreceptor agonist which shows improvement in patients symptoms.

References

1. Kullander S Terbutaline inhalation for alleviation of severe pain in essential dysmenorrhea. Acta Obstetricia et Gynecologica Scandinavica 1981;425-7