Analgesia (narcotic)
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
I
|
Supportive (Green)
|
Pain relief
|
Patient
|
ED-MD
|
Attard AR., Corlett MJ., Kidner NJ., et al. Safety of early pain relief for acute abdominal pain. BMJ 1992; 305:554-6. Medline
|
I
|
Supportive (Green)
|
Mortality
|
Patient
|
ED-MD
|
Bartfield JM., Flint RD., McErlean M., Broderick J. Nebulized fentanyl for relief of abdominal pain. Acad Emerg Med 2003; 10(3):215-8. Medline
|
I
|
Supportive (Green)
|
Pain Scale
|
Patient
|
ED-MD
|
Birnbaum A., Esses D., Bijur PE., Holden L., Gallagher EJ. Randomized double-blind placebo-controlled trial of two intravenous morphine dosages (0.10 mg/kg and 0.15 mg/kg) in emergency department patients with moderate to severe acute pain. Ann Emerg Med 2007; 49(4):445-53. Medline
|
I
|
Supportive (Green)
|
Analgesia
|
Patient
|
ED-MD
|
Chinn E, Friedman BW, Naeem F, Irizarry E, Afrifa F, Zias E, et al. Randomized Trial of Intravenous Lidocaine Versus Hydromorphone for Acute Abdominal Pain in the Emerg Department. Ann Emerg Med 2019; 74(2):233-40. Medline
|
I
|
Supportive (Green)
|
VAS relief > 15 mm in pain
|
Patient
|
ED-MD
|
Deaton T., Auten JD., Darracq MA. Nebulized fentanyl vs intravenous morphine for ED patients with acute abdominal pain: A randomized double-blinded, placebo-controlled clinical trial. Am J Emerg Med 2015; 33(6):791-5. Medline
|
I
|
Supportive (Green)
|
Pain relief using visual analog scale
|
Patient
|
ED-MD
|
Gallagher EJ., Esses D., Lee C., Lahn M., Bijur PE. Randomized clinical trial of morphine in acute abdominal pain. Ann Emerg Med 2006; 48(2):150-60. Medline
|
I
|
Supportive (Green)
|
Resolution of symptoms
|
Patient
|
ED-MD
|
LoVecchio F., Oster N., Sturmann K., et al. The use of analgesics in patients with acute abdominal pain. J Emerg Med 1997; 15:775-9. Medline
|
I
|
Supportive (Green)
|
Pain relief
|
Patient
|
ED-MD
|
Miller JP., Schauer SG., Ganem VJ., Bebarta VS. Low-dose ketamine vs morphine for acute pain in the ED: A randomized controlled trial. Am J Emerg Med 2015; 33(3):402-8. Medline
|
I
|
Supportive (Green)
|
analgesia
|
Patient
|
ED-MD
|
Pace S., Burke TF. Intravenous morphine for early pain relief in patients with acute abdominal pain. Acad Emerg Med 1996; 3:1086-92. Medline
|
I
|
Supportive (Green)
|
Diagnosis accuracy
|
Patient
|
ED-MD
|
Vermeulen B., Morabia A., Unger CF, et al. Acute appendicitis: Influence of early pain relief on the accuracy of clinical and US findings in the decision to operate a randomized trial. Radiology 1999; 210:639-643. Medline
|
I
|
Supportive (Green)
|
Pain relief
|
Patient
|
ED-MD
|
Yuan Y., Chen JY., Guo H., Zhang Y., Liang DM., Zhou D., et al. Relief of abdominal pain by morphine without altering physical signs in acute appendicitis. Chin Med J (Engl) 2010; 123(2):142-145. Medline
|
I
|
Neutral (Yellow)
|
Impact on diagnostic accuracy
|
Patient
|
ED-MD
|
Thomas SH., Silen W., Cheema F., Reisner A., Aman S., Goldstein JN., et al. Effects of morphine analgesia on diagnostic accuracy in Emergency Department patients with abdominal pain: a prospective, randomized trial. J Am Coll Surg 2003; 196(1):18-31. Medline
|
II
|
Supportive (Green)
|
Pain intensity
|
Patient
|
ED-MD
|
Muntlin A., Carlsson M., Safwenberg U., Gunningberg L. Outcomes of a nurse-initiated intravenous analgesic protocol for abdominal pain in an emergency department: A quasi-experimental study. Int J Nurs Stud 2011; 48(1):13-23. Medline
|
II
|
Supportive (Green)
|
Analgesia
|
Patient
|
PH-Paramedic
|
Ricard-Hibon A., et al. Compliance with a morphine protocol and effect on pain relief in out-of-hospital patients. J Emerg Med 2008; 34:305-10. Medline
|
III
|
Supportive (Green)
|
Efficacy
|
Patient
|
ED-MD
|
O'Connor A., Schug SA., Cardwell H. A comparison of the efficacy and safety of morphine and pethidine as analgesia for suspected renal colic in the emergency setting. J Accid Emerg Med 2000; 17(4):261-4. Medline
|
III
|
Supportive (Green)
|
Pain relief
|
Patient
|
ED-MD
|
Olsen JC., McGrath NA., Schwarz DG., Cutcliffe BJ., Stern JL. A double-blind randomized clinical trial evaluating the analgesic efficacy of ketorolac versus butorphanol for patients with suspected biliary colic in the emergency department. Acad Emerg Med 2008; 15(8):718-22. Medline
|
III
|
Supportive (Green)
|
Analgesia
|
Patient
|
PH-Paramedic
|
Rickard C., et al. A RCT of intranasal fentanyl vs intravenous morphine for analgesia in the prehospital setting. Am J Emerg Med 2007; 25:911-7. Medline
|
III
|
Neutral (Yellow)
|
Decrease in pain
|
Patient
|
ED-MD
|
Bijur PE., Kenny MK., Gallagher EJ. Intravenous Morphine at 0.1mg/kg is not effective for controlling severe acute pain in the majority of patients. Annals of Emergency Medicine 2005; 46(4):362-7. Medline
|
III
|
Neutral (Yellow)
|
Rate of missed appendicitis
|
Process
|
ED-MD
|
Green R., Bulloch B., Kabani A., Hancock BJ., Tenenbein M. Early analgesia for children with acute abdominal pain. Pediatrics 2005; 116(4):978-83. Medline
|