NEW YORK — Early use of analgesia in patients with abdominal pain is not associated with a delay in the diagnosis of acute appendicitis, according to findings from a case-control study.
“In the past surgical literature, there have been statements that we should not give early analgesia to patients with undifferentiated abdominal pain until we have a surgical consultation or a final disposition is determined,” said Steven P. Frei, M.D., an emergency physician at Lehigh Valley Hospital and Health Network, Allentown, Pa.
Previous studies that have questioned this reasoning have primarily used surrogate markers such as examination findings before and after analgesia rather than actual outcomes such as true delayed diagnosis of acute appendicitis, Dr. Frei said at the annual meeting of the Society for Academic Emergency Medicine.
In a study of 961 adults with acute appendicitis who were treated by emergency physicians in a three-hospital health network during 1998–2002, 132 patients who had a delayed diagnosis were no more likely to have taken either a nonsteroidal anti-inflammatory drug (NSAID) or opiate within 2 hours of their initial exam than were 132 control patients who did not have a delayed diagnosis of acute appendicitis, Dr. Frei reported.
Similar percentages of patients with a delayed diagnosis and patients without a delayed diagnosis had early use of the NSAID ketorolac (20% vs. 17%, respectively), an opiate (26% vs. 21%), or any of those two types of drugs (41% vs. 35%); some patients received both kinds of medication.
The investigators matched the control patients with cases on age, gender, Alvarado score (a numeric value based on eight signs and symptoms of acute appendicitis), and year of diagnosis. They defined patients with a delayed diagnosis as those who were discharged after their first emergency department visit or had longer than a 20-hour delay from the initial examination to surgery.
The findings did not change when patients with a delayed diagnosis were compared with all patients in the database who had a nondelayed diagnosis, not just nondelayed patients who were matched with delayed-diagnosis patients.
Most patients receiving analgesic medication early had 30 mg of ketorolac intravenously and/or parenteral dosing of 4–6 mg of morphine, 50–75 mg of meperidine, or 50–100 mcg of fentanyl.