Aghamohammadi Dawood, Gholipouri Changiz, Hosseinzadeh Hamzeh, Khajehee Mohammad Ali, Ghabili Kamyar, Golzari Samad Ej
Department of Anesthesia, Tabriz University of Medical Sciences, Tabriz, Iran.
J Cardiovasc Thorac Res. 2012;4(2):45-8. doi: 10.5681/jcvtr.2012.011. Epub 2012 Sep 8.
Acute surgical abdomen is one of the most common emergency surgical causes all over the world and also one of the most important abdominal pain causes which is sometimes intolerable for the patients referring to the emergency departments. Diagnosis and planning for operation in these cases is based on time-demanding serial examinations and results of paraclinical data. In this waiting period, patients have to tolerate pain.Therefore, we aimed to study the hypothesis that relieving pain has no influence on valuable findings in physical examination.
This double blind randomized clinical trial was carried out on 120 patients above 12 years old referred to an emergency department of a referral hospital with acute abdomen. Patients were divided into two groups of receiving intravenous placebo and Morphine randomly. Pain score, change in tenderness as well as change in rebound tenderness before and after receiving morphine or placebo were measured based on Numeric Pain Assessment Scale.
Statistically significant difference was observed between both groups regarding the mean pain score. Prevalence of tenderness and rebound tenderness after medication administration revealed a significant difference between two groups. Furthermore, pain and tenderness showed a significant decrease in patients receiving morphine also a significant difference occurred in rebound tenderness between two groups.
Despite the fact that opioid analgesics decrease pain in patients with acute surgical abdomen, they do not tend to eliminate required diagnostic data being obtained from physical examination like tenderness and rebound tenderness. Surprisingly, all the acute abdomen cases had rebound tenderness after morphine administration. Therefore, this research advises a cautious usage of morphine in patients with acute abdomen.
急性腹痛是全球最常见的急诊外科病因之一，也是最重要的腹痛病因之一，对于前往急诊科就诊的患者而言，有时疼痛难以忍受。这些病例的诊断和手术规划基于对时间要求严格的系列检查以及辅助临床数据的结果。在此等待期间，患者必须忍受疼痛。因此，我们旨在研究缓解疼痛对体格检查中有价值的发现无影响这一假设。
本双盲随机临床试验对120名12岁以上因急腹症前往一家转诊医院急诊科就诊的患者进行。患者被随机分为接受静脉注射安慰剂和吗啡的两组。根据数字疼痛评估量表测量接受吗啡或安慰剂前后的疼痛评分、压痛变化以及反跳痛变化。
两组在平均疼痛评分方面存在统计学显著差异。用药后压痛和反跳痛的发生率在两组之间显示出显著差异。此外，接受吗啡的患者疼痛和压痛显著减轻，两组之间反跳痛也存在显著差异。
尽管阿片类镇痛药可减轻急性腹痛患者的疼痛，但它们并不会消除从体格检查中获得的如压痛和反跳痛等所需诊断数据。令人惊讶的是，所有急腹症病例在使用吗啡后均出现反跳痛。因此，本研究建议对急性腹痛患者谨慎使用吗啡。
