Analgesia and assessment of abdominal pain
Report by Kevin Mackway-Jones, Consultant Search checked by Magnus Harrison Research Fellow
Clinical scenario
A 12 year old girl presents to the emergency department with “tummy ache”. The history and examination are suggestive of appendicitis. You call the surgical team but they are unable to attend for one hour as they are busy in theatre. You wonder if giving analgesia will affect the accuracy of the surgical diagnosis.
Three part question
In a [patients with abdominal pain] does [analgesia prior to surgical consultation] affect [the accuracy of surgical diagnosis]?
Search strategy
Medline 1966 to 12/99 using the OVID interface. ([ exp abdominal pain OR abdominal pain$.mp OR exp peritonitis OR peritonitis.mp] OR {[exp pain OR pain$.mp] AND [abdom$.mp OR exp stomach OR stomach.mp OR tummy.mp]}) AND [exp analgesia OR exp morphine OR exp analgesia, opioid OR analgesi$.mp] AND maximally sensitive RCT filter LIMIT to human and english.
Search outcome
Altogether 78 papers were found of which 73 were irrelevant or of insufficient quality for inclusion. The remaining five papers are shown in table 4.
Comment
All the studies show considerable benefit to the patient from pain relief with either no change in diagnostic accuracy or an improvement.
Clinical bottom line
Patients with acute, atraumatic abdominal pain should have analgesia administered without delay.
Report by Kevin Mackway-Jones, Consultant Search checked by Magnus Harrison Research Fellow
