[Use of opioid analgesics in diagnosis and decision-making in patients with acute nontraumatic abdominal pain. A systematic review of the literature].

Abstract

INTRODUCTION:

The use of analgesics during the diagnosis and decision-making process in patients with acute nontraumatic abdominal pain is controversial. The aim of the present study was to determine whether the use of opioid analgesics in patients with acute nontraumatic abdominal pain increases the risk of diagnostic error.

METHOD:

We performed a systematic review of the literature. Randomized clinical trials (RTCs) comparing the use of opioid analgesics with placebo administered before any procedure in patients with acute nontraumatic abdominal pain were included. There was no restriction on language. RTCs unrelated to this subject were excluded. The variables analyzed were age, gender, and the percentage of adverse effects, appendicitis, changes on physical examination and diagnostic error, modification of pain severity measured by a visual analog scale, and methodological quality of the studies. A search was performed in the MEDLINE and Cochrane databases, using MeSH terms. Each article was analyzed by applying a methodological quality score through which weighted means were applied for each variable. The Chi-square and Student's t-test were applied to compare the groups.

RESULTS:

Six articles meeting the selection criteria were found. The mean methodological quality score was 21.6 points. The studies represented a population of 363 patients treated with opioids and 336 patients treated with placebo. There were no differences in the mean age of the patients (39.4 vs 39.6 years), distribution by gender, prevalence of acute appendicitis (23.3% vs 24%) or diagnostic error (15.6% vs 21.1%; p = 0.0637). Differences were found in the variable of pain reduction (27.2 vs 7.2 mm, respectively; p = 0.0167).

CONCLUSIONS:

The use of opioid analgesics in patients with acute nontraumatic abdominal pain does not increase the risk of diagnostic error and reduces pain during the decision-making process.

• Authors: Carlos Manterola, Viviana Pineda, Manuel Vial, Paula Astudillo
• Journal: Cirugia espanola (Cir Esp) Vol. 81 Issue 2 Pg. 91-5 (Feb 2007) ISSN: 0009-739X [Print] Spain
• Vernacular Title: Utilización de analgésicos opiáceos en el proceso diagnóstico y de toma de decisiones sobre pacientes con dolor abdominal agudo no traumático. Revisión sistemática de la literatura.
• PMID: 17306125 (Publication Type: Journal Article, Review, Systematic Review)

Chemical References

• Analgesics, Opioid

Topics

• Abdominal Pain (diagnosis, drug therapy, etiology)
• Acute Disease
• Analgesics, Opioid
• Diagnostic Errors
• Humans
• Randomized Controlled Trials as Topic