Administration of analgesia for acute abdominal pain sufferers in the accident and emergency setting.
BACKGROUND
Recent trials suggest that the early administration of analgesia in patients with acute abdominal pain facilitates examination and does not delay diagnosis. We investigated current practice regarding analgesia for these patients.


METHODS
All patients admitted via the accident and emergency department with abdominal pain were included. The main outcome measures evaluated were waiting time for analgesia and its relationship to subjective visual analogue pain scores and clinical diagnoses.


RESULTS
Data from 107 consecutive patients were investigated; seven patients were excluded. Forty-two per cent were male. The mean age was 40.1 years (6-85). The mean overall waiting time for analgesia was 1.4 h (2 min to 14 h). Sixty-seven per cent received analgesia within one hour, although 22% waited 2-14 h after presentation. Those with mild pain waited significantly longer for analgesia (mean 247 min) than those with severe pain (mean 82 min; P=0.01). Those with moderate pain had intermediate waiting times (mean 111 min), although they were not statistically different from the severe group (P=0.43). Female patients had to wait longer (mean 129 min) than male patients (mean 69 min; P=0.09 analysis of variance). Of 64% who were general practitioner referrals, only 11% (all severe group, P=0.02) received analgesia in the community. Neither clinical diagnosis nor age influenced the timing of analgesia. Seventy-three per cent received analgesia in the casualty department (mean 0.5 h; range 0.02-3.2), whereas those admitted in the ward without receiving analgesia in casualty had to wait significantly longer for their pain relief (mean 5 h; 1.2-14).


CONCLUSIONS
This study shows the need for standardized protocols for analgesia usage in patients presenting with acute abdominal pain.
Shabbir
Jamshed
J
Department of Surgery, Wexford General Hospital, Wexford, Ireland. jshabbir@aol.com
Ridgway
Paul F
PF
Lynch
Katy
K
Law
Ching E R
CE
Evoy
Dennis
D
O'Mahony
John B
JB
Mealy
Ken
K
D000006:Abdomen, Acute / Q000175:diagnosis / Q000188:drug therapy*; D000059:Accidents; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000379:methods / Q000592:standards; D000700:Analgesics / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D004008:Diclofenac / Q000008:administration & dosage / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004630:Emergencies; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008614:Meperidine / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome
D000700:Analgesics; D004008:Diclofenac; D008614:Meperidine