Diagnosis unaffected by giving children narcotics for abdominal pain

Journal of Family Practice, July, 2005

* Clinical Question

Does giving a narcotic to children with abdominal pain obscure the surgical diagnosis?

Study Design

Randomized controlled trial (double-blinded)

Allocation

Concealed

Setting

Emergency department

Synopsis

These researchers enrolled children aged 4 to 15 years who came to the emergency department with acute abdominal pain of less than 7 days' duration and had pain scores of 5 cm or higher on a 10-cm visual analog scale. The children were randomly assigned (concealed allocation) to receive oxycodone buccally (0.1 mg/kg) or placebo. The 63 children were asked to rate their pain every 30 minutes for up to 3.5 hours after treatment. One of 3 study surgeons evaluated each child, provided a provisional diagnosis (appendicitis, nonspecific abdominal pain, or other), a differential diagnosis, and initial management (observation or surgery), and assessed whether there was abdominal guarding. The same surgeon re-examined the patient 1 hour after the first dose of the study drug and provided the same assessments as at baseline.

Researchers contacted the children with nonspecific abdominal pain 4 weeks later. The main outcomes were difference in pain intensity, the presence of abdominal guarding before and after medication, and the diagnostic accuracy between the oxycodone and placebo groups. The authors don't say whether these were assessed via intention to treat. The children receiving oxycodone began experiencing pain relief within the first 30 minutes. The diagnostic accuracy was not adversely affected by the administration of the drug. The study was powerful enough to detect modest differences in pain intensity.

* Bottom Line

Giving analgesics to children with abdominal pain does not obscure the surgical diagnosis. We don't need to make kids suffer while waiting for a surgeon to evaluate their abdominal pain. (LOE=2b)

Kokki H, Lintula H, Vanamo K, Heiskanen M, Eskelinen M. Oxycodone vs placebo in children with undifferentiated abdominal pain: a randomized, double-blind clinical trial of the effect of analgesia on diagnostic accuracy. Arch Pediatr Adolesc Med 2005; 159:320-325.