Preconsultation use of analgesics on adults presenting to the emergency department with acute appendicitis

Abstract

Objective: 279 cases of appendicitis were reviewed and compared for the difference between those patients who received pain medication before consulting a surgeon and those who were not treated with analgesics. Methods: All patients aged 15 years and older who underwent appendicectomy for appendicitis between 1 July 2001 and 30 June 2002 were divided into group 1 (those who received preconsultaion use of analgesics) and group 2 (those who were not treated with analgesics). The following measures were compared: age, sex, symptom duration, initial vital signs, white blood cell counts, frequency of imaging studies, time to operative intervention, and operative findings. Continuous and categorical variables were analysed using t and x 2 tests, respectively. Results: A total of 279 patients were included for analysis. Patient details (age, sex, symptom duration) of the two study groups were similar. There was no statistically significant difference between group 1 and group 2 with respect to vital signs (systolic blood pressure, pulse rate, respiratory rate, body temperature), white blood cell counts, and frequency of imaging studies (ultrasound, computed tomography). There was no significant difference in the rate of perforated appendicitis between the two study groups although a shorter median time to operative intervention has been found in the group who received analegesia. Conclusion: The preconsultation use of analgesics in ED patients with a final diagnosis of appendicitis is not associated with a longer delay to operative intervention and is not associated with an increased rate of perforated appendicitis.A ppendicitis is a common cause of acute abdominal pain. 1 Most patients present initially to the emergency department (ED). Because of its highly variable historical and physical manifestations and its inconsistent course, delayed or missed diagnosis of appendicitis continues to be one of the most frequent causes of medical malpractice claims and settlements for emergency physicians. 2 3 Early administration of analgesics in this group of patients might have confused the picture further.In the past, early analgesia was considered inadvisable as it could mask physical signs and hence delay diagnosis and intervention. 4 Recently, this point of view has been challenged. Pain control is at present considered an integral part of patient resuscitation as it minimises stress responses and facilitates patient cooperation during physical examination. [5][6][7] Although more and more authors argue that early pain relief is safe in abdominal pain patients, many practising surgeons still believe that pain drugs would interfere with diagnostic accuracy. 8 Various studies attempted to assess the safety of analgesia in abdominal pain patients with clinical end points mostly focused on the effects of analgesia on abdominal signs, diagnosis confidence, management, and disposition decisions from the points of view of the operating surgeons. In this study, we evaluated the effects of analgesia prescribed by emergency physicia...

Do Opiates Affect the Clinical Evaluation of Patients With Acute Abdominal Pain?

“…Two retrospective analyses of patients with proven appendicitis did not find any difference in the rate of perforated appendicitis between patients who received or did not receive analgesia. 13,43 Reports of analgesia administration leading to adverse consequences remain limited to case reports. 15 While giving opiates to patients with acute abdominal pain appears to alter the physical examination, the use of opiates leads to virtually no increase in incorrect management decisions.…”

Morphine analgesia in patients with acute appendicitis: a randomised double-blind clinical trial

“…Chong et al 20 reviewed the hospital charts of 297 patients with appendicitis and found that the use of parenteral analgesics before the consultation did not cause a significant delay to surgery and was not associated with an increased rate of serious complications such as perforated appendicitis 20. Vermeulen et al reported improvement in pain severity without changing the appropriateness of the surgeon’s decision-making 21.…”