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Best evidence topic report
Analgesia and assessment of abdominal pain
Free
  1. Kevin Mackway-Jones,
  2. Magnus Harrison
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL

    http://dx.doi.org/10.1136/emj.17.2.128-a

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      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.

      View this table:
      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

      References

      1. Zoltie N, Cust MP. Analgesia in the acute abdomen. J R Coll Surg Engl1986;68:209–10.
      2. Attard AR, Corlett MJ, Kidner NJ, et al. Safety of early pain relief for acute abdominal pain. BMJ1992;305: 554–6.
      3. Pace S, Burke TF. Intravenous morphine for early pain relief in patients with acute abdominal pain. Acad Emerg Med1996;3:1086–92.
        OpenUrlPubMedWeb of Science
      4. LoVecchio F, Oster N, Sturmann K, et al. The use of analgesics in patients with acute abdominal pain. J Emerg Med1997;15:775–9.
        OpenUrlCrossRefPubMed
      5. Vermeulen B, Morabia A, Unger PF, et al. Acute appendicitis: influence of early pain relief on the accuracy of clinical and US findings in the decision to operate—a randomized trial. Radiology1999;210:639–43.
        OpenUrlPubMedWeb of Science

      Footnotes

      • The BMA library supplied the papers.