Although pain was a common criterion for nonresponse and appendectomy , analgesic regimens were poorly described .
BACKGROUND Meta-analyses and a recent guideline acknowledge that conservative management of uncomplicated appendicitis with antibiotics can be successful for patients who wish to avoid surgery .
However , guidance as to specific management does not exist .
Effects of morphine analgesia on diagnostic accuracy in Emergency Department patients with abdominal pain: a prospective, randomized trial.
BACKGROUND Because of concerns about masking important physical findings , there is controversy surrounding whether it is safe to provide analgesia to patients with undifferentiated abdominal pain . The purpose of this study was to address the effects of analgesia on the physical examination and diagnostic accuracy for patients with abdominal pain . STUDY DESIGN The study was a prospect i ve , double-blind clinical trial in which adult Emergency Department ( ED ) patients with undifferentiated abdominal pain were r and omized to receive placebo ( control group , n = 36 ) or morphine sulphate ( MS group , n = 38 ) . Diagnostic and physical examination assessment s were recorded before and after a 60-minute period during which study medication was titrated . Diagnostic accuracy and physical examination changes were compared between groups using univariate statistical analyses . RESULTS There were no differences between control and MS groups with respect to changes in physical or diagnostic accuracy . The overall likelihood of change in severity of tenderness was similar in MS ( 37.7 % ) as compared with control ( 35.3 % ) patients ( risk ratio [ RR ] 1.07 , 95 % confidence interval [ CI ] 0.64 - 1.78 ) . MS patients were no more likely than controls to have a change in pain location ( 34.0 % versus 41.2 % , RR 0.82 , 95 % CI 0.50 - 1.36 ) . Diagnostic accuracy did not differ between MS and control groups ( 64.2 % versus 66.7 % , RR 0.96 , 95 % CI 0.73 - 1.27 ) . There were no differences between groups with respect to likelihood of any change occurring in the diagnostic list ( 37.7 % versus 31.4 % , RR 1.20 , 95 % CI 0.71 - 2.05 ) . Correlation with clinical course and final diagnosis revealed no instance of masking of physical examination findings . CONCLUSIONS Results of this study support a practice of early provision of analgesia to patients with undifferentiated abdominal pain
Although pain was a common criterion for nonresponse and appendectomy , analgesic regimens were poorly described .
BACKGROUND Meta-analyses and a recent guideline acknowledge that conservative management of uncomplicated appendicitis with antibiotics can be successful for patients who wish to avoid surgery .
However , guidance as to specific management does not exist .