Early analgesic treatment regimens for patients with acute abdominal pain: a nationwide survey among general surgeons

Villain, Cédric; Wyen, H.; Ganzera, Silke; Marjanović, Goran; Lefering, Rolf; Ansorg, Jörg; Gaidzik, Peter W.; Haubold, N.; Neugebauer, Edmund

doi:10.1007/s00423-013-1063-8

Cited by 6 publications

(4 citation statements)

References 23 publications

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“…There is ongoing controversy about whether pain should be relieved in patients with undiagnosed AAP. [13,14] Some clinicians adhere to the surgical dictum: analgesia should be withheld from patients with AAP, as it may hinder a correct diagnosis. [14] At present, whether to treat the treatment of patients with unknown abdominal pain depends mainly on the doctor's habits and experience.…”

Section: Discussionmentioning

confidence: 99%

A retrospective study of patients complaining of nontraumatic acute abdominal pain, admitted in the emergency department of an urban hospital in China

Luo

Liu

Zhang

et al. 2023

Emerg Crit Care Med

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BackgroundNontraumatic acute abdominal pain (AAP) accounts for a large proportion of emergency department (ED) admissions. This study aimed to explore the underlying correlations among basic information, imaging examinations, and diagnoses.MethodsA total of 7453 patients complaining of AAP, admitted to the ED of Zhongnan Hospital of Wuhan University, were enrolled in this retrospective study from January 1 to December 30, 2019. We collected the following information from the patients: sex, age, date of visit, pain location, nature of pain, level of severity, imaging (computed tomography, x-ray, and ultrasound), diagnosis, and outcomes (release from the hospital, transfer to another hospital, transfer to another department, observation room, hospitalization, or death).ResultsAccording to this study, AAP was more common in female than male. A total of 82.11% patients of AAP were in level 3 of severity, while 0.19% patients were in level 1. A total of 77.20% of the patients had undergone imaging. Swelling pain and colic are the 2 most common types of AAP. Nonspecific abdominal pain (NSAP) is the most common diagnosis. In the diagnosis of NSAP and gastroenteritis, female patients were more prevalent than male patients, but for renal colic, male patients were 3 times as many as female patients. Nonspecific abdominal pain, biliary colic, and cholecystitis are the 3 leading causes in patients 65 years or older. Nonspecific abdominal pain, renal colic, and gastroenteritis are the 3 leading causes of AAP in patients younger than 65 years.ConclusionWith the help of imaging, clinicians can specify a diagnosis and perform corresponding treatment in most cases. However, making a precise diagnosis of AAP within a short period is still challenging. Further research should be conducted to seek safer and more effective techniques to streamline clinicians’ work.

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Section: Discussionmentioning

confidence: 99%

A retrospective study of patients complaining of nontraumatic acute abdominal pain, admitted in the emergency department of an urban hospital in China

Luo

Liu

Zhang

et al. 2023

Emerg Crit Care Med

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“…32,33 In a number of previous surveys of emergency physicians 23,28 and surgeons 19 , a large proportion of respondents chose not to provide analgesia until after surgical consultation. This practice has long impeded timely administration of analgesia 34 or led to analgesia being withheld altogether.…”

Section: Discussionmentioning

confidence: 99%

“…17 Moreover, untreated pain in childhood has been reported to lead to long-term negative outcomes such as anxiety, hyperesthesia, and needle phobia. 18 Notwithstanding the above, few EDs have policies guiding pain management in patients with acute abdominal pain, 1,19 and a 2012 study reported that analgesia is not provided to one-third of children with abdominal pain. 20 It is thus imperative to explore reasons behind withholding analgesia, and, more speficially, the relationship of the practice of withholding analgesia with surgical consultation, in order to inform knowledge translation initiatives to improve care.…”

Section: Introductionmentioning

confidence: 99%

Reported provision of analgesia to patients with acute abdominal pain in Canadian paediatric emergency departments

Poonai

Cowie

Davidson

et al. 2016

CJEM

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Objectives: Evidence exists that analgesics are underutilized, delayed, and insufficiently dosed for emergency department (ED) patients with acute abdominal pain. For physicians practicing in a Canadian paediatric ED setting, we (1) explored theoretical practice variation in the provision of analgesia to children with acute abdominal pain; (2) identified reasons for withholding analgesia; and (3) evaluated the relationship between providing analgesia and surgical consultation. Methods: Physician members of Paediatric Emergency Research Canada (PERC) were prospectively surveyed and presented with three scenarios of undifferentiated acute abdominal pain to assess management. A modified Dillman's Tailored Design method was used to distribute the survey from June to July 2014. Results: Overall response rate was 74.5% (149/200); 51.7% of respondents were female and mean age was 44 (SD 8.4) years. The reported rates of providing analgesia for case scenarios representative of renal colic, appendicitis, and intussusception, were 100%, 92.1%, and 83.4%, respectively, while rates of providing intravenous opioids were 85.2%, 58.6%, and 12.4%, respectively. In all 60 responses where the respondent indicated they would obtain a surgical consultation, analgesia would be provided. In the 35 responses where analgesia would be withheld, 21 (60%) believed pain was not severe enough, while 5 (14.3%) indicated it would obscure a surgical condition. Conclusions: Pediatric emergency physicians self-reported rates of providing analgesia for acute abdominal pain scenarios were higher than previously reported, and appeared unrelated to request for surgical consultation. However, an unwillingness to provide opioid analgesia, belief that analgesia can obscure a surgical condition, and failure to take self-reported pain at face value remain, suggesting that the need exists for further knowledge translation efforts. RÉSUMÉObjectifs: D'après des données, il y a une sous-utilisation, un report de l'administration et un dosage insuffisant de l'analgésie dans les services des urgences (SU) chez les patients souffrant de douleurs abdominales aiguës. En ce qui concerne les médecins qui pratiquent dans les services des urgences pédiatriques (SUP) au Canada, les auteurs ont : 1) examiné les différences de pratique théorique dans l'administration de l'analgésie chez les enfants souffrant de douleurs abdominales aiguës; 2) cerné les motifs à l'appui du report de l'administration de l'analgésie; et 3) évalué le lien entre l'administration de l'analgésie et les consultations en chirurgie.

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“…Analgesia in the setting of undifferentiated abdominal pain has long been an area for controversy; the idea is that "covering the physical findings" will worsen outcomes [8,214]. Fortunately, there are sufficient data refuting this idea-an idea based upon historical cautions formulated due to problems with large opioid doses in the preradiology era-that the question has been answered to a reasonable degree of certainty [179,[215][216][217][218][219][220][221][222][223][224][225][226]. A variety of opioids (including the atypical agent tramadol) have been assessed, as administered a variety of ways ranging from IV bolus [227] to nebulized opioid [228] to patient-controlled analgesia [179], but the bottom line is that existing evidence does not support a practice of having patients suffer to preserve the physical examination [8].…”

Section: Special Issues Withmentioning

confidence: 99%

Management of Pain in the Emergency Department

Thomas

2013

ISRN Emergency Medicine

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Since pain is a primary impetus for patient presentation to the Emergency Department (ED), its treatment should be a priority for acute care providers. Historically, the ED has been marked by shortcomings in both the evaluation and amelioration of pain. Over the past decade, improvements in the science of pain assessment and management have combined to facilitate care improvements in the ED. The purpose of this review is to address selected topics within the realm of ED pain management. Commencing with general principles and definitions, the review continues with an assessment of areas of controversy and advancing knowledge in acute pain care. Some barriers to optimal pain care are discussed, and potential mechanisms to overcome these barriers are offered. While the review is not intended as a resource for specific pain conditions or drug information, selected agents and approaches are mentioned with respect to evolving evidence and areas for future research.

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Early analgesic treatment regimens for patients with acute abdominal pain: a nationwide survey among general surgeons

Cited by 6 publications

References 23 publications

A retrospective study of patients complaining of nontraumatic acute abdominal pain, admitted in the emergency department of an urban hospital in China

A retrospective study of patients complaining of nontraumatic acute abdominal pain, admitted in the emergency department of an urban hospital in China

Reported provision of analgesia to patients with acute abdominal pain in Canadian paediatric emergency departments

Management of Pain in the Emergency Department

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