Morphine analgesia in patients with acute appendicitis: a randomised double-blind clinical trial

Amoli, Hadi Ahmadi; Golozar, Asieh; Keshavarzi, Sepiedeh; Tavakoli, Hassan; Yaghoobi, A

doi:10.1136/emj.2007.050914

Cited by 31 publications

(18 citation statements)

References 22 publications

(26 reference statements)

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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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“…Several studies (Attard et al, 1992;Pace and Burke, 1996;LoVecchio et al, 1997;Vermeulen et al, 1999;Mahadevan and Graff, 2000;Thomas et al, 2003;Gallagher et al, 2006;Amoli et al, 2008) and one Cochrane review published in 2007 (Manterola et al, 2007), which was updated in 2011 (Manterola et al, 2011), have demonstrated that administering analgesia for acute abdominal pain is appropriate prior to the diagnosis regardless of the aetiology of the abdominal pain. The authors of the Cochrane review concluded that the use of opioid analgesics neither increased the risk of misdiagnosis nor increased the risk of incorrect treatment decisions being made; the Cochrane reviewers furthermore stated that pain therapy may, in fact, make the clinical examination easier in patients with an acute abdomen.…”

Section: Pre-diagnostic Analgesiamentioning

confidence: 99%

“…One-dimensional scales such as the visual analogue scale (VAS), verbal rating scale (VRS) and numerical rating scale (NRS), as well as the 'Smiley analogue scale' (SAS) are used in the acute setting ( Fig. 1) (Todd et al, 1996;Kelly, 1998;Gallagher et al, 2001;Marinsek et al, 2007;Amoli et al, 2008;Daoust et al, 2008;Jawaid et al, 2009;Sharwood and Babl, 2009). Limitations for pain measurement include disturbances of consciousness, impaired vision and language barriers (Gallagher et al, 2001).…”

Section: Pain Intensity Assessmentmentioning

confidence: 99%

“…Untreated pain affects patient comfort and impairs the organism, with sometimes far-reaching and enduring negative consequences (Amoli et al, 2008). In this light, every patient should be offered adequate and timely pain therapy when indicated.…”

Section: Summary and Recommendationsmentioning

confidence: 99%

“…Notably, the net result is that up to three-quarters of all these patients initially have analgesics withheld from them (Jawaid et al, 2009). In contrast to these fears, several evidence-based studies (Attard et al, 1992;Pace and Burke, 1996;LoVecchio et al, 1997;Vermeulen et al, 1999;Mahadevan and Graff, 2000;Thomas et al, 2003;Gallagher et al, 2006;Amoli et al, 2008), and one Cochrane review (Manterola et al, 2011), support prompt analgesia administration prior to the aetiological diagnosis of acute abdominal pain patients. Pain therapy should, therefore, no longer be withheld from or delayed for these patients, and it should be initiated prior to diagnosis after assessment of relevant pain characteristics, by administering the most appropriate analgesic agents in a timely manner.…”

Section: Summary and Recommendationsmentioning

confidence: 99%

See 2 more Smart Citations

Treatment of acute abdominal pain in the emergency room: A systematic review of the literature

Falch

Vicente

Häberle

et al. 2014

European Journal of Pain

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Appropriate pain therapy prior to diagnosis in patients with acute abdominal pain remains controversial. Several recent studies have demonstrated that pain therapy does not negatively influence either the diagnosis or subsequent treatment of these patients; however, current practice patterns continue to favour withholding pain medication prior to diagnosis and surgical treatment decision. Populations; and (6) Ethical and Medico-legal Considerations in Current Analgesia Practices. A comprehensive algorithm for analgesia for acute abdominal pain in the general adult population was developed. A review of the literature of common aetiologies and management of acute abdominal pain in the general adult population and special patient populations seen in the emergency room revealed that intravenous administration of paracetamol, dipyrone or piritramide are currently the analgesics of choice in this clinical setting. Combinations of non-opioids and opioids should be administered in patients with moderate, severe or extreme pain, adjusting the treatment on the basis of repeated pain assessment, which improves overall pain management.

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Racial Disparities in Pain Management of Children With Appendicitis in Emergency Departments

et al. 2015

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Morphine analgesia in patients with acute appendicitis: a randomised double-blind clinical trial

Abstract: NCT00477061.

Cited by 31 publications

References 22 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

Treatment of acute abdominal pain in the emergency room: A systematic review of the literature

Racial Disparities in Pain Management of Children With Appendicitis in Emergency Departments

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