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Abdominal Pain

Date Last Search Run: Feb 01, 2022
Table last updated: May 02, 2021
Data last added: Mar 31, 2021

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)      
2 (fair evidence exists)      
3 (weak evidence exists)    


Interventions

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

Analgesia (NSAIDs)
Level Direction Primary Outcome Patient/Process Setting Reference
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

Fentanyl
Level Direction Primary Outcome Patient/Process Setting Reference
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
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

Ketamine
Level Direction Primary Outcome Patient/Process Setting Reference
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) Reduction in pain using NRS Patient ED-MD Motov S, Mann S, Drapkin J, Butt M, Likourezos A, Yetter E, et al. Intravenous subdissociative-dose ketamine versus morphine for acute geriatric pain in the Emergency Department A randomized controlled trial. Am J Emerg Med 2019; 37(2) 220-7. Medline
III Supportive (Green) Reduction in pain Patient ED-MD Goltser A., Soleyman-Zomalan E., Kresch F., Motov S. Short (low-dose) ketamine infusion for managing acute pain in the ED: Case-report series. Am J Emerg Med 2015; 33(4):e5-7. Medline

Nitrous Oxide
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Patient satisfaction Patient PH-Paramedic Johnson JC., Atherton Gl. Effectiveness of Nitrous Oxide in a rural EMS System. The Journal of Emergency Medicine 1991; 9:45-53. Medline


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