Intravenous Morphine for Early Pain Relief in Patients with Acute Abdominal Pain

Pace, Steven; Burke, Teresa

doi:10.1111/j.1553-2712.1996.tb03365.x

Cited by 144 publications

(78 citation statements)

References 13 publications

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“…38 Still, we believe that 14% remains unacceptably high; ample evidence currently supports the pre-diagnostic administration of analgesia. 13,14,[39][40][41][42][43][44][45][46] Furthermore, although the proportion of respondents withholding analgesia due to the belief it may mask a surgical diagnosis is significantly lower than reported in other studies, it still portends a delayed approach to providing analgesia in children with abdominal pain and emphasizes the need for wider knowledge translation. Although the majority of respondents indicated they would provide analgesia in an appendicitis scenario (and AAP recommends to provide systemic opioids for severe pain 40 ), less than two-thirds of survey respondents reported a willingness to provide intravenous opioids, despite a pain score of 8 out of 10.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…[9][10][11][12] Pace and Burke [9] conducted the first randomized double-blind controlled trial with adequate allocation concealment in ED patients with acute abdominal pain in 1996 and concluded that morphine did not lead to any diagnostic error or physical examination alteration. Contrary to these results, physical examination findings changed in the present study, but did not lead to any diagnostic error.…”

Section: Discussionmentioning

confidence: 99%

Randomized controlled trial of morphine in elderly patients with acute abdominal pain

Güngör¹,

Kartal²,

Bektaş³

et al. 2012

Ulus Travma Acil Cerrahi Derg

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“…This belief has been refuted by several studies, which show that diagnostic accuracy is the same [1][2][3] or better 4 in patients who receive opioid analgesia.…”

Section: Introductionmentioning

confidence: 86%

Selected Articles: The impact of parenteral opioid analgesics on sonographic and clinical diagnostic accuracy for suspected acute appendicitis

Bullard

Sookram

Campana

1999

CJEM

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Intravenous Morphine for Early Pain Relief in Patients with Acute Abdominal Pain

Abstract: When compared with saline placebo, the administration of MS to patients with acute abdominal pain effectively relieved pain and did not alter the ability of physicians to accurately evaluate and treat patients.

Cited by 144 publications

References 13 publications

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

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

Randomized controlled trial of morphine in elderly patients with acute abdominal pain

Selected Articles: The impact of parenteral opioid analgesics on sonographic and clinical diagnostic accuracy for suspected acute appendicitis

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