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Opiates & the Acute Abdomen

caesar ursic trauma-list@trauma.org
Sun, 13 Apr 2003 09:43:48 -0700 (PDT)

Well said.  But I'll play devil's advocate here and
counter with the following:

"While pain relief is indeed a vital imperative, an
equal if not greater one is the prompt and accurate
diagnosis and treatment of the patient's underlying

Thus, if the adminstration of an opiate could
potentially and significantly impede such
diagnosis/therapy, its administration to the patient
with a potential acute abdomen should be closely
studied before proclaiming that it has no significant
effect. The burden of proof might therefore be
transferred to those who propose using opiates.

N.B.: I'm not saying that pain relief and accurate
diagnosis/therapy are mutually exclusive imperatives;
I am saying that most the data that claim that the
former does not adversly affect the latter isn't very
convincing due to the study designs used. 

C.M. Ursic, M.D.
Dept. of Surgery
UCSF-East Bay
Oakland, California

--- Avi Roy Shapira <avir@bgumail.bgu.ac.il> wrote:
> Let me just say this:  Relief of pain is a
> categorical imperative for a
> physician.  Consequently, the burden of proof that
> administering morphine
> interferes with physical examination is on those who
> wish not to give
> it. Not the other way around. 
> I think giving morphine does not mask acute abdomen.
> On the contrary, I
> often give morphine when the patient was previously
> tested for rebound
> tenderness, and now wont allow anyone to touch him,
> or creates boardlike
> voluntary guarding. 
> Show me that it is harmful, and I shall stop.  
> Avi 
> Aviel Roy-Shapira, M.D.              Soroka
> University Hospital &
> Dept. of Surgery A. and              Ben-Gurion
> University Medical School 
> the Critical Care Unit               POB 151, Beer
> Sheva, Israel
> email:avir@bgumail.bgu.ac.il        
> Fax:972-7-6403260 voice:972-7-6403390
> --
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