title: Opioid analgesia and assessment of the sonographic Murphy sign.
abstract: Administration of intravenous opioid analgesia to patients with undifferentiated abdominal pain remains a controversial topic in many emergency departments. To determine whether opioid analgesia impacts assessment of the sonographic Murphy sign (SM) in evaluating acute gallbladder disease (GBD), a retrospective chart review was undertaken. The chart review encompassed 119 patients, 21% of whom, having received opioid analgesia before ultrasound, constituted the opioid group. Between the opioid and control (i.e., no opioid analgesia) groups, there were no significant differences in SM sensitivity (48.2%; CI 28.7-68.1% vs. 68.8%; CI 41.3-89%, respectively) or specificity (92.5%; CI 83.4-97.5% vs. 88.9%; CI 51.8-99.7%, respectively) for GBD. There was no association between opioid analgesia and false-positive SM (OR 0.74, CI 0.08-6.65), or false-negative SM (OR 1.42, CI 0.46-4.43). We conclude that the test characteristics of SM are unaffected by opioid analgesia.
authors.affiliation: Division of Emergency Medicine & Harvard Affiliated Emergency Medicine Residency, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Bret P
authors.initials: BP
authors.lastname: Nelson
authors.forename: Emily L
authors.initials: EL
authors.lastname: Senecal
authors.forename: Christine
authors.initials: C
authors.lastname: Hong
authors.forename: Thomas
authors.initials: T
authors.lastname: Ptak
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Thomas
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy* / Q000209:etiology; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography
chemical_list: D000701:Analgesics, Opioid