Original ContributionsProspective randomized study of analgesic use for ED patients with right lower quadrant abdominal pain☆,☆☆,★,★★
Section snippets
Methods
The study was conducted in Singapore at the National University Hospital, which provides urban tertiary care with an annual ED census of 85,000. A convenience sample of patients greater than 11 years of age who presented to our ED with right lower quadrant pain less than a week's duration (nontraumatic in origin) suggestive of acute appendicitis was included. Approval for the study was obtained from the hospital's Human Research Committee and patients were enrolled over a 6-month period from
Results
A total of 68 patients were randomized into two groups. There were 34 patients in the treatment group and 34 in the placebo group with one patient excluded from each group after randomization because of one having an incomplete record and the other absconding before study completion. Clinical findings in both groups (Table 1) were similar except for the greater representation of women in the treatment group.
Empty Cell Analgesic Group Empty Cell
Discussion
What constitutes a significant change in abdominal examination findings has not been precisely defined by prior studies. In three previous studies the investigators concluded that the administration of analgesics to abdominal pain patients resulted in some physical finding changes6, 8, 12 whereas in another study it was reported that there were “no changes in peritoneal signs.”7 The changes in abdominal signs reported were not quantified or qualified in any of these studies.
In our study we
Conclusions
Parenteral tramadol results in a decrease in the level of abdominal pain in patients with RLQ abdominal pain. This effect was achieved in this study without causing normalization of abdominal examination findings that were indicative of acute appendicitis.
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Cited by (60)
Safety and impact on diagnostic accuracy of early analgesia in suspected acute appendicitis: A meta-analysis
2013, International Journal of SurgeryCitation Excerpt :Some papers showed paradoxical results9,10 in that tenderness could be better appreciated after opiate administration, facilitating diagnosis. According to Mahadevan et al.,15 pain relief improved patient collaboration and diagnostic accuracy. All other cited RCTs showed that early analgesia did not influence diagnostic accuracy.
Analgesia in Patients With Acute Abdominal Pain: To Withhold or Not to Withhold?
2008, Annals of Emergency MedicineIs early analgesia associated with delayed treatment of appendicitis?
2008, American Journal of Emergency MedicineCitation Excerpt :It was thought that analgesia could confuse the clinical examination. However, recent studies concluded that early analgesia inabdominal pain cases does not adversely affect treatment [1-11]. Yet, less attention has been given to actual outcomes than to other markers of diagnostic accuracy, such as physicians' diagnostic impressions or physical examination signs.
Appendicitis
2023, Acute Care Surgery and Trauma: Evidence-Based Practice: Third EditionAbdominal pain
2021, Emergency Medical Services: Clinical Practice and Systems Oversight: Third Edition
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Returned January 26, 2000.
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Address reprint requests to Malcolm Mahadevan, MD, 129 Hillcrest Road, Singapore 288999. E-mail: [email protected]
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Am J Emerg Med 2000;18:753-756
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0735-6757/00/1807-0002$10.00/0