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Critically reappraising the literature-driven practice of analgesia administration for acute abdominal pain in the emergency room prior to surgical evaluation
Journal article   Peer reviewed

Critically reappraising the literature-driven practice of analgesia administration for acute abdominal pain in the emergency room prior to surgical evaluation

Steven A Nissman, Lewis J Kaplan and Barry D Mann
The American journal of surgery, v 185(4)
2003
DOI: https://doi.org/10.1016/S0002-9610(02)01412-5
PMID: 12657376
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Abdominal pain Acute abdomen Analgesics Emergency department Opioids
Classic teaching is that narcotic analgesia in the setting of an acute abdomen can alter physical examination findings and should therefore be withheld until after a surgeon’s examination. A telephone survey of emergency medicine physicians representing 60 US hospitals was conducted to assess the current practices and opinions regarding the early administration of narcotic analgesia in this setting. Relevant literature was also reviewed for methodological errors. Fifty-nine of 60 (98.3%) respondents reported that it is their practice to administer analgesia prior to surgical evaluation. Of these, only 9 of 59 (15.3%) reported always informing the surgeon prior to dosing the patient. The two most common motivations cited were that patient discomfort takes precedence (52 of 59; 88.1%) and that the literature supports the practice to be safe (51 of 59; 86.4%). It is common for emergency medicine physicians to medicate acute abdomen patients prior to surgical evaluation. Numerous significant study limitations and design flaws were found that question the validity of the four clinical trials supporting this practice. Because many physicians base their clinical decisions on these trials, a careful analysis of their shortcomings, as well as our own personal experiences and practice recommendations, is discussed.

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5 Record Views
29 citations in Web of Science
34 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Surgery
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