Early analgesic treatment regimens for patients with acute abdominal pain: a nationwide survey among general surgeons.

ABSTRACT

INTRODUCTION: Early pain relief in patients with acute nontraumatic abdominal pain in emergency departments has been discussed for years. Some randomized trials have addressed this issue but conclusive data are lacking. In this study, we assessed the current treatment practice in German hospitals in order to evaluate the necessity of a further clinical trial. METHODS: An online survey containing 27 questions was sent to general and visceral surgeons at attending level using a mailing list provided by the Professional Board of German Surgeons (BDC) using a standard interview software. The questionnaire collected demographic data, current treatment policies about frequency of early analgesia, types of pain medication, and opinions about their use and effects. RESULTS: Four hundred ninety-five completed questionnaires were returned. Many surgeons were cautious about early analgesia in the emergency department. Forty-five percent of the surgeons would provide analgesia prior to diagnosis to the majority of patients. Within the departments, differing opinions existed regarding the analgesic treatment (41 %). Thirty-two percent of all the respondents knew about a false diagnosis after early analgesia. There was heterogeneity in the estimation of the impact of pain medication on masking of clinical symptoms. A randomized controlled trial would be supported by the majority of respondents. As influencing factors for withdrawing early analgesia, we found the examiner being over 40 years of age (p < 0.05), low experience with the clinical picture of acute abdominal pain (p < 0.05), high estimation of the masking of clinical findings (p < 0.001), and knowing about a false diagnosis after early analgesia (p < 0.001) to be significant. CONCLUSION: Discordance in the analgesic treatment regimens in patients with acute abdominal pain still exists in German hospitals. The topic remains subject of frequent discussions. More high quality data are needed before a clear guideline can be given for implementation in clinical routine management.