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Self-Assessment Questions

Emergency Medicine

Answer 3
  1. Generally, intravenous opioids are safe for management of acute abdominal pain. Seventy-five years ago, Sir Zachary Cope’s writings led to the withholding of pain relief in all patients with acute abdominal pain.2 Today intensive care units provide continuous monitoring that was not available to Cope and his colleagues, and the use of balanced fluid therapy and safe broad-spectrum antibiotics helps to stabilize patients. The false belief that pain medications mask physical signs and delay diagnosis and treatment is a common reason for withholding analgesia; this belief has been disputed by scientific studies.3,4 Fear of risks such as addiction, respiratory depression, and medical-legal complications are conjectural and unsubstantiated.5 Ketorolac is popular in the ED as a universal pain medication because of its lack of opioid-related side effects. However, limitations of ketorolac compared with opioid analgesics include higher expense, less ability to titrate, a low therapeutic ceiling, and the inability to be reversed.

     Silen W: Cope’s Early Diagnosis of the Acute Abdomen, 19th ed. New York: Oxford University Press, 1996.

    3. Zoltie N, Cust MP: Analgesia in the acute abdomen. Ann R Coll Surg Engl 1986;68:209-210.

    4. Attard AR, Corlett MJ, Kidner NJ, et al: Safety of early pain relief for acute abdominal pain. BMJ 1992;305:554556.

    5. Lee JS, Stiell IG, Shapiro S, et al: Physicians’ attitudes toward opioid analgesic use in acute abdominal pain [Abstract]. Acad Emerg Med 1996;3:494.

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