Critically reappraising the literature-driven practice of analgesia administration for acute abdominal pain in the emergency room prior to surgical evaluation

Background Classic teaching is that narcotic analgesia in the setting of an acute abdomen can alter physical examination findings and should therefore be withheld until after a surgeon’s examination. Methods A telephone survey of emergency medicine physicians representing 60 US hospitals was conducted to assess the current practices and opinions regarding the early administration of narcotic analgesia in this setting. Relevant literature was also reviewed for methodological errors. Results Fifty-nine of 60 (98.3%) respondents reported that it is their practice to administer analgesia prior to surgical evaluation. Of these, only 9 of 59 (15.3%) reported always informing the surgeon prior to dosing the patient. The two most common motivations cited were that patient discomfort takes precedence (52 of 59; 88.1%) and that the literature supports the practice to be safe (51 of 59; 86.4%). Conclusions 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.