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Am Fam Physician. 2007;76(7):971

Opioid Analgesia During Evaluation of Acute Abdominal Pain

Clinical Question

Does providing early opioid analgesia during evaluation of acute abdominal pain improve patient comfort or outcomes?

Evidence-Based Answer

Providing early opioid analgesia to patients presenting with acute abdominal pain does not affect or delay management decisions, but it lessens pain intensity as rated by the patient.

Practice Pointers

The differential diagnosis of acute abdominal pain includes many causes that may require urgent surgical treatment or hospitalization such as appendicitis, cholecystitis, bowel obstruction, kidney stones, perforated peptic ulcer, pancreatitis, diverticulitis, pelvic abscesses, and ectopic pregnancy. Most acute abdominal pain is visceral pain, which is characterized by generalized aching, pressure, or sharp pain. Visceral pain generally responds best to intraspinal local anesthetic or nonsteroidal anti-inflammatory drugs or opioids administered via any route.1 It is common practice to withhold opioid analgesia in patients with acute abdominal pain. This practice is based on the theory that opioids might mask symptoms, causing inaccurate or delayed diagnostic and treatment decisions.

To evaluate the accuracy of this theory, the authors of this Cochrane review searched for randomized controlled trials comparing opioid analgesia with no analgesia in adults with abdominal pain. Six trials, including 699 total patients, were identified. Most of the trials compared 5 to 15 mg of morphine (Duramorph) with an equivalent amount of saline. There were no significant differences between groups in changes in the physical examination, errors in treatment decisions, inaccurate diagnoses, nausea and vomiting, or length of hospitalization. The two studies that reported patient comfort found significant improvement with opioids. There was not enough information to determine if opioid use causes a delay in the decision to operate, affects costs, or affects morbidity. There was also insufficient evidence to suggest an optimal treatment regimen.

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