49
views
0
recommends
+1 Recommend
0 collections
    4
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Preoperative pain treatment in acute abdomen in Osogbo, Nigeria: a randomized double-blind placebo-controlled study

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Withholding analgesics in acute abdomen for fear of masking clinical features and impairing diagnosis and decision-making is still being practiced despite recent evidence to the contrary. This study assesses the effect of preoperative analgesia on clinical findings, clinical diagnosis, and decision-making in patients with non-trauma acute abdomen.

          Method

          This is a randomized, double-blind, placebo-controlled study using Tramal, a brand of tramadol, at the ED of LAUTECH Teaching Hospital Osogbo, Nigeria. Ninety-five patients between 18–60 years received Tramal ( n = 46) or placebo ( n = 49). The pain score, clinical findings, provisional diagnosis, and treatment plan were noted before and 15–20 min after administration of the analgesic or placebo. The final diagnosis arrived at after adequate investigation or operation was considered the gold standard. The pain scores, diagnosis, treatment plan, and decision between the two groups were compared. Statistical analysis was by SPSS 16. Results were considered statistically significant at p < 0.05.

          Results

          Demography and case distribution were similar in both groups. The improvement in pain was greater in the Tramal group ( p = 0.001). The abdominal palpation findings were also better in the Tramal group ( p = 0.02). There were more changes in the diagnosis after use of Tramal ( p = 0.01). There were more changes in the decision in the Tramal group ( p = 0.03). Most of the changes in diagnosis and decision in the Tramal group were for the better.

          Conclusion

          The preoperative use of Tramal in acute abdomen improved the experience of pain and did not adversely affect the accuracy of the diagnosis or decision-making.

          Related collections

          Most cited references20

          • Record: found
          • Abstract: not found
          • Article: not found

          Inadequate analgesia in emergency medicine

            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Inadequate analgesia in emergency medicine.

            Review of emergency department pain management practices demonstrates pain treatment inconsistency and inadequacy that extends across all demographic groups. This inconsistency and inadequacy appears to stem from a multitude of potentially remediable practical and attitudinal barriers that include (1) a lack of educational emphasis on pain management practices in nursing and medical school curricula and postgraduate training programs; (2) inadequate or nonexistent clinical quality management programs that evaluate pain management; (3) a paucity of rigorous studies of populations with special needs that improve pain management in the emergency department, particularly in geriatric and pediatric patients; (4) clinicians' attitudes toward opioid analgesics that result in inappropriate diagnosis of drug-seeking behavior and inappropriate concern about addiction, even in patients who have obvious acutely painful conditions and request pain relief; (5) inappropriate concerns about the safety of opioids compared with nonsteroidal anti-inflammatory drugs that result in their underuse (opiophobia); (6) unappreciated cultural and sex differences in pain reporting by patients and interpretation of pain reporting by providers; and (7) bias and disbelief of pain reporting according to racial and ethnic stereotyping. This article reviews the literature that describes the prevalence and roots of oligoanalgesia in emergency medicine. It also discusses the regulatory efforts to address the problem and their effect on attitudes within the legal community.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Safety of early pain relief for acute abdominal pain.

              (a) to determine the efficacy of papaveretum in treating pain when administered early to patients presenting with acute abdominal pain and (b) to assess its effect on subsequent diagnosis and management. Prospective, randomised, placebo controlled study. Walsgrave Hospital, Coventry. 100 consecutive patients with clinically significant abdominal pain who were admitted as emergencies to a surgical firm. Intramuscular injection of up to 20 mg papaveretum or an equivalent volume of saline. Pain and tenderness scores, assessment of patient comfort, accuracy of diagnosis, and management decisions. Median pain and tenderness scores were lower after papaveretum (pain score 8.3 in control group and 3.1 in treatment group, p < 0.0001; tenderness score 8.1 in control group and 5.1 in treatment group, p < 0.0001). Forty eight patients were deemed to be comfortable after papaveretum compared with nine after saline. Incorrect diagnoses and management decisions applied to two patients after papaveretum compared with nine patients after saline. Early administration of opiate analgesia to patients with acute abdominal pain can greatly reduce their pain. This does not interfere with diagnosis, which may even be facilitated despite a reduction in the severity of physical signs. These patients should not be denied effective treatment.
                Bookmark

                Author and article information

                Journal
                Int J Emerg Med
                Int J Emerg Med
                International Journal of Emergency Medicine
                Springer
                1865-1380
                2013
                23 January 2013
                : 6
                : 3
                Affiliations
                [1 ]Department of Surgery, LAUTECH Teaching Hospital, Osogbo, Nigeria
                [2 ]Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile- Ife, Nigeria
                [3 ]Department of Obstetrics and Gyneacology, Obafemi Awolowo University Teaching Hospital Complex, Ile- Ife, Nigeria
                Article
                1865-1380-6-3
                10.1186/1865-1380-6-3
                3562156
                23343476
                756934f7-e9a7-4864-a560-ab45069e7b84
                Copyright ©2013 Agodirin et al.; licensee Springer.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 April 2012
                : 10 December 2012
                Categories
                Original Research

                Emergency medicine & Trauma
                acute abdomen,analgesic,diagnosis,opioids,preoperative
                Emergency medicine & Trauma
                acute abdomen, analgesic, diagnosis, opioids, preoperative

                Comments

                Comment on this article

                scite_

                Similar content315

                Cited by3

                Most referenced authors125