Oxycodone vs Placebo in Children With Undifferentiated Abdominal Pain

Kokki, Hannu; Lintula, Hannu; Vanamo, Kari; Heiskanen, Marjut; Eskelinen, Matti

doi:10.1001/archpedi.159.4.320

Cited by 48 publications

(20 citation statements)

References 16 publications

(37 reference statements)

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“…In the study by Green et al, 36 this estimate was not available, and the final (postintervention) score was used in the meta-analysis. Kokki et al 37 reported a summed and maximal pain intensity difference. The latter was incorporated into the meta-analysis because we believed it most closely parallels measures of pain in other studies.…”

Section: Summary Measures and Synthesis Of Resultsmentioning

confidence: 99%

“…The latter was incorporated into the meta-analysis because we believed it most closely parallels measures of pain in other studies. 37 Kim et al 38 reported differences in pain scores as median and interquartile range. Efforts to obtain the original data for parametric analyses were unsuccessful and the results were not included in the meta-analyses.…”

Section: Summary Measures and Synthesis Of Resultsmentioning

confidence: 99%

“…The reasons for exclusion were non-RCTs or exclusively adult trials (n = 19), studies of analgesia prior to anesthetic induction (n = 3), nonopioid interventions (n = 1), and outcomes unrelated to our objectives (n = 2). All six included publications were published in peerreviewed journals [26][27][28][36][37][38] and provided data on 342 participants. With the exception of Amoli et al 27 and Uledi et al, 28 all studies enrolled pediatric patients exclusively.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Opioid Analgesia for Acute Abdominal Pain in Children: A Systematic Review and Meta‐analysis

Poonai

Paskar

Konrad

et al. 2014

Academic Emergency Medicine

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Objectives: There are long-held concerns that analgesia in patients with acute abdominal pain may obscure the physical examination and lead to missing a diagnosis of appendicitis. Despite evidence to the contrary, analgesia continues to be underutilized and suboptimally dosed in children with acute abdominal pain. The objective of this systematic review and meta-analysis was to determine if opioids provide analgesia without an increase in side effects and appendicitis-related complications.Methods: Trials were identified through electronic searches of MEDLINE (1946MEDLINE ( -2013, EMBASE (1980EMBASE ( -2013, Cochrane Central Register of Controlled Trials (2013), CINAHL (1981CINAHL ( -2013, and Google Scholar (2013). All randomized controlled trials (RCTs) of children aged 0-18 years with acute abdominal pain that compared any opioid analgesic to placebo were included. The methodologic qualities of studies and the overall quality of evidence were evaluated using the Cochrane Collaboration's Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation system, respectively.Results: Six RCTs met inclusion criteria, and each compared a single-dose parenteral opioid to a placebo, providing data on 342 children aged 5 to 18 years. The pooled mean pre/post difference in selfreported pain scores was 19.61 mm (95% confidence interval [CI] = -1.16 to 40.37 mm) lower in those receiving opioid analgesia. There was no significant increase in the risk of perforation or abscess associated with opioids in cases of appendicitis (relative risk [RR] = 1.03, 95% CI = 0.55 to 1.93). The risk of side effects was significantly greater in patients who received opioids (RR = 6.06, 95% CI = 1.10 to 33.49). Subtherapeutic dosing of opioids was detected in all six trials. Conclusions:The use of opioids in undifferentiated acute abdominal pain in children is associated with no difference in pain scores and an increased risk of mild side effects. However, there is no increased risk of perforation or abscess. The overall quality of evidence is low, suggesting the need for larger, high-quality trials that are powered to detect both serious complications of appendicitis and determine the most efficacious opioid dosing for children.ACADEMIC EMERGENCY MEDICINE 2014;21:1183-1192© 2014 3 Historically, the reluctance among clinicians to provide analgesia to patients with acute abdominal pain 4-6 was thought to be due to concerns of obscuring the diagnosis of appendicitis and delayed management. 7,8 Indeed, pediatric emergentologists have identified disapproval by their surgical colleagues as a barrier to providing analgesia.6 Despite a decade of evidence that opioid analgesia is not associated with an increased risk of diagnostic or management errors, 9,10 this phenomenon continues to be reported. A recent literature review in adults highlighted a lack of therapeutic consensus and an ongoing practice pattern that favors withholding analgesia prior to surgical evaluation.11 Another recent study of children with...

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Section: Summary Measures and Synthesis Of Resultsmentioning

confidence: 99%

Section: Summary Measures and Synthesis Of Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Opioid Analgesia for Acute Abdominal Pain in Children: A Systematic Review and Meta‐analysis

Poonai

Paskar

Konrad

et al. 2014

Academic Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…Providers were initially resistant to enrolling patients in the study because of the fear of providing analgesia to these patients, although this is unsupported by much of the published literature to date. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Assembly bias may have been generated by non-consecutive patient enrollment. Patients collected by convenience or because the physician suggested enrollment in a study may be a subset of the population unless all patients are contributed to the study.…”

Section: Commentarymentioning

confidence: 99%

“…4 In the past decade there has been growing evidence demonstrating that opioid analgesia is safe and appropriate in ED patients with undifferentiated acute abdominal pain. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] The literature has documented how pain is an inadequately treated symptom in the ED. This may be related, in part, to our current emergency medicine culture.…”

Section: Introductionmentioning

confidence: 99%