Thirty-one studies were included in the review (n=1,105), including six RCTs (n=128). RCTs had PEDro scores that ranged from 5 to 10 (good to excellent). Most of the non-RCTs had D&B scores lower than 15 points.
Strategies to reduce/prevent episodes of autonomic dysreflexia (botulinum toxin injections, capsaicin, urinary bladder surgical augmentation, epidural anaesthesia, intraoperational anaesthesia by general or spinal anaesthesia) were supported by level 4 (pre-post studies) and level 5 (observational studies) evidence.
Initial acute management of an episode of autonomic dysreflexia by non-pharmacologic means (positioning the patient upright, loosening tight clothing, eliminating any participating stimulus) was supported by level 5 clinical consensus and physiologic data.
There was no evidence to support use of anticholinergics or topical anaesthetic in prevention of autonomic dysreflexia. Evidence for use of sacral deafferentation and lidocaine was conflicting.
Pharmacologic management of autonomic dysreflexia with anti-hypertensive drugs in the presence of sustained elevated blood pressure was supported by level 1 evidence for prazosin and level 2 evidence for nifedipine and prostaglandin E2. Level 4 and 5 evidence supported use of nitrates, captopril, terazosin and there was conflicting evidence for phenoxybenzamine. There was no evidence to support use of sildenafil.