Classic teaching is that narcotic analgesia in the setting of an acute abdomen can alter physical examination findings. It should therefore be withheld until after a surgeon's examination.
In this study, a research team from the United States conducted a telephone survey of emergency medicine physicians representing 60 hospitals. They assessed the current practices and opinions regarding the early administration of narcotic analgesia in this setting.
The team also reviewed the relevant literature for methodological errors.
|Only 15% of emergency physicians always informed the surgeon prior to administering analgesia.|
|American Journal of Surgery|
The researchers found that 98% of respondents reported that it is their practice to administer analgesia prior to surgical evaluation.
They also found that of these, only 15% always informed the surgeon prior to dosing the patient.
The most common motivations cited by respondents were that patient discomfort takes precedence (88%), and that the literature supports the practice to be safe (86%).
Dr Steven Nissman's team concluded, "It is common for emergency medicine physicians to medicate acute abdomen patients prior to surgical evaluation".
"Numerous significant study limitations and design flaws were found that question the validity of the four clinical trials supporting this practice".
"Because many physicians base their clinical decisions on these trials, a careful analysis of their shortcomings, as well as our own personal experiences and practice recommendations, is discussed."