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Opiates & the Acute AbdomenDunn Matthew Dr. (RJC) ACCIDENT & EMERGENCY - SwarkHosp-TR firstname.lastname@example.org
Fri, 11 Apr 2003 12:35:00 +0100
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> This month's lead article in the American Journal of > Surgery (Nissman SA, Kaplan LJ, Mann BD. Critically > reappraising the literature-driven practice of > analgesia administration for acute abdominal pain in > the emergency room prior to surgical evaluation. Am J > Surg 2003;185:291-96) addresses the once (still?) > controversial practice of administering narcotics to > patients suspected of harboring intraabdominal > pathology before the arrival of the consulting > surgeon. At best the > supporting evidence comes from four studies that were > flawed in design and/or examined insufficient numbers > of patients. Not a very systematic review. There is a vast body of evidence supporting the hypothesis that analgesia is effective for acute abdominal pain. The studies on diagnostic accuracy are too small to exclude a small improvement or worsening of diagnostic accuracy with analgesia. Thomas SH et al. Effects of morphine analgesia on diagnostic accuracy in emergency department patients with abdominal pain: A prospective, randomized trial. J Am Coll Surg 2003 Jan; 196: 18-31. is one more recent study supporting the hypothesis that diagnostic accuracy is similar or improved in patients given analgesia. > I believe this is a relevant > issue in trauma care as well, given the significant > numbers of patients we are asked to see by the ER > service who did not initially meet full trauma > activation criteria yet in whom there is a question of > intraabdominal injury. Do we need to rehash the literature on diagnostic accuracy abdominal examination in blunt trauma? Even in the alert orientated patient without distracting injuries, the great majority of patients with a positive abdominal exam have no significant intraabdominal injury, and a significant minority of patients with a negative exam have a significant injury. > The point is that there is no good data > that proves that premedicationg these patients does > not affect the surgeons ability to render an accurate > diagnosis. Equally, no good data that proves that premedicating does not improve diagnostic accuracy. My personal experience is that it does. Matt Dunn Warwick This email has been scanned for viruses by NAI AVD however we are unable to accept responsibility for any damage caused by the contents. The opinions expressed in this email represent the views of the sender, not South Warwickshire General Hospitals NHS Trust unless explicitly stated. If you have received this email in error, please notify the sender.