<p>Neuroleptanalgesia for acute abdominal pain: a systematic review</p>

Abstract

Background Acute abdominal pain (AAP) comprises up to 10% of all emergency department (ED) visits. Current pain management practice is moving toward multi-modal analgesia regimens that decrease opioid use. Objective This project sought to determine whether, in patients with AAP (population), does administration of butyrophenone antipsychotics (intervention) compared to placebo, usual care, or opiates alone (comparisons) improve analgesia or decrease opiate consumption (outcomes)? Methods A structured search was performed in Cochrane CENTRAL, CINAHL, Database of Abstracts of Reviews of Effects, Directory of Open Access Journals, Embase, IEEE-Xplorer, Latin American and Caribbean Health Sciences Literature, Magiran, PubMed, Scientific Information Database, Scopus, TÜBİTAK ULAKBİM, and Web of Science. Clinical trial registries ( ClinicalTrials.gov , World Health Organization International Clinical Trials Registry Platform, and Australian New Zealand Clinical Trials Registry), relevant bibliographies, and conference proceedings were also searched. Searches were not limited by date, language, or publication status. Studies eligible for inclusion were prospective randomized clinical trials enrolling patients (age ≥18 years) with AAP treated in acute care environments (ED, intensive care unit, postoperative). The butyrophenone must have been administered either intravenously or intra-muscularly. Comparison groups included placebo, opiate only, corticosteroids, non-steroidal anti-inflammatory drugs, or acetaminophen. Results We identified 7,217 references. Six studies met inclusion criteria. One study assessed ED patients with AAP associated with gastroparesis, whereas five studies assessed patients with postoperative AAP: abdominal hysterectomy (n=4), sleeve gastrectomy (n=1). Three of four studies found improvements in pain intensity with butyrophenone use. Three of five studies reported no change in postoperative opiate consumption, while two reported a decrease. One ED study reported no change in patient satisfaction, while one postoperative study reported improved satisfaction scores. Both extrapyramidal side effects (n=3) and sedation (n=3) were reported as unchanged. Conclusion Based on available evidence, we cannot draw a conclusion on the efficacy or benefit of neuroleptanalgesia in the management of patients with AAP. However, preliminary data suggest that it may improve analgesia and decrease opiate consumption.

Pain management in the emergency department: a clinical review

“…Additionally, haloperidol binds to the histamine receptors, alpha-2 adrenergic receptors, 5HT-2 receptors and NMDA receptors and decreases hyperalgesia produced by chronic opioid use. 47 Droperidol is a butyrophenone derivative with potent dopamine D2 antagonist actions with additional actions such as A2 adrenoceptor agonist and 5HT-3, muscarinic and nicotinic receptors antagonist. 48 Haloperidol and droperidol have been used in the ED as an adjunct in treatment of headache, 49 abdominal pain associated with cannabinoid hyperemesis syndrome, 50 gastroparesis and cyclic vomiting syndrome, 51 and chronic pain not responsive to opioids.…”

Does administration of haloperidol or ketorolac decrease opioid administration for abdominal pain patients? A retrospective study

“…Haloperidol, a butyrophenone antipsychotic medication, has limited evidence for its efficacy in acute pain, and studies have focused on the use of oral antipsychotics as adjunctive therapies [4]. In fact, in a recent systematic review of butyrophenone antipsychotics for acute abdominal pain, the authors concluded "we cannot draw a conclusion on the efficacy or benefit of neuroleptanalgesia in the management of patients with [acute abdominal pain]" [5]. However, recent educational programs have also emphasized the role of haloperidol for chronic pain patients in the ED with little supporting evidence [6].…”