Clinicians have traditionally withheld opiate analgesia from patients with acute abdominal pain until after evaluation by a surgeon.
This was done out of concern that analgesia may alter the physical findings and interfere with diagnosis.
Dr Sumant Ranji and colleagues from California determined the impact of opiate analgesics on clinical examination and operative decision for acute abdominal pain.
The team used data sources and selected studies from MEDLINE and EMBASE to 2006.
The research team conducted hand searches of article bibliographies to identify placebo-controlled randomized trials of opiate analgesia.
The studies reported changes in the history, physical examination findings, or diagnostic errors.
Diagnostic errors were defined as the performance of unnecessary surgery or failure to perform necessary surgery in a timely fashion.
|3 pediatric studies showed a nonsignificant absolute decrease in diagnosis|
|Journal of the American Medical Association|
Data was extracted by 2 authors independently reviewed each study, abstracted data, and classified study quality.
A third reviewer independently resolved discrepancies.
The team identified 9 studies conducted in adults and 3 in children.
These studies showed trends toward increased risks of altered findings on the abdominal examination due to opiate administration.
The team restricted the analysis to the 8 adult and pediatric studies that reported significantly greater analgesia with opiates compared with placebo.
The researchers observed that the risk of physical examination changes became significant.
These studies exhibited significant heterogeneity, and only 2 trials distinguished changes such as loss of peritoneal signs from all other changes.
Consequently, the team analyzed risk of diagnostic errors as a marker for important changes in the physical examination.
Opiate administration had no significant association with management errors.
The 3 pediatric studies showed a nonsignificant absolute decrease in diagnostic errors.
The research team noted that opiate administration was associated with a nonsignificant absolute decrease in the risk of diagnostic errors.
Dr Ranji's team concludes, “Opiate administration may alter the physical examination findings, but these changes result in no significant increase in diagnostic errors.”
“The existing literature does not rule out a small increase in errors.”
“However, this error rate reflects a conservative definition in which surgeries labeled as either delayed or unnecessary may have met appropriate standards of care.”
“In published research reports, no patient experienced major morbidity or mortality attributable to opiate administration.”