Pain control will not affect the diagnosis of appendicitis in children
何天輝(Thien-Fiew Ho);陳樞鴻(Shu-Hung Chen)
Introduction: Traditional surgical practice recommended against giving analgesia to pain with acute abdominal pain until a definite treatment plan was established. However, there is increasing evidence from current literature that early analgesia does not adversely affect the accuracy of the diagnosis or decision-making in adults with abdominal pain. For children, there are still a limited number of studies to support this. Materials and Methods: A search for English language literatures in October 2014 was conducted via PUBMED search engine and OVID search engine. The search was conducted using the following medical subject headings and key words: abdominal pain or appendicitis and analgesics or opioid and children. References were crosschecked for additional studies not found in the searched database. Results: The search of literature revealed four randomized and control trials. All studies used a 10cm Visual Analogue Scale to access pain. Overall, the analgesia group was associated with significant reduction in pain Kim et al. showed no significant change in the area of tenderness or in the diagnostic accuracy with the intravenous morphine group. Green et al. showed morphine administration did not increase the rate of missed appendicitis, and the rate of perforated appendicitis was unaffected by the treatment of morphine, while morphine was found to decrease pain score significantly. Kokki et al. found no difference in the rate of delayed or unnecessary surgery between opioid and placebo groups. Bailey et al. showed the use of morphine in children with suspected appendicitis did not delay the surgical decision. Conclusions: These systemic reviews, and together with additional retrospective studies of available literature clearly support that opioid analgesics can be safely given before full assessment and diagnosis in acute abdomen pain suspecting appendicitis, without increasing the risk of errors in diagnosis or treatment.