Pain Management for Acute Abdomen in the ED
Posted by webmaster on July 17 2007 22:12:02

It has been a conventional attitude, widely prevalent among surgeons, that patients who present to the Emergency department with acute abdomen pain should not be administered pain relief until assessment is over. This surgical dictum was outlined by Sit. Zachary Cope in 1957 because it could impair clinical diagnostic accuracy.

As academic emergency physicians, let us review the lessons learnt over the past ten years about analgesic usage in patients in acute abdomen pain. Over the past three years, several published articles including that of Gallagher and co-workers (Annals of Emergency Medicine -Volume 48, August 2006) have observed that intravenous morphine, as a pain relief measure, has improved diagnostic accuracy by up to 15%.
The data is clearly consistent with the recommendation that morphine can safely be provided without impairing clinical diagnostic accuracy. However, advocates against the notion have been quick to point out methodological limitations in published studies and the fact that the clinician evaluating the patients before and after analgesia was not a surgeon.

Changing a conventional belief is a slow and arduous process. As Emergency physicians let us recall the philosophy of our specialty:

-To alleviate pain and distress
-To attend and rectify the patients present unstable condition.
-To investigate the cause

Prof. Suresh David MS (Surg) MPhil FACEM
CMC Vellore