EARLY ANALGESIA FOR CHILDREN WITH ACUTE ABDOMINAL PAIN: IS IT APPLICABLE WITHOUT AFFECTING DIAGNOSTIC ACCURACY?

Key words: Acute abdominal pain, Children, Analgesia, Randomized Controlled Trial

Background Many paediatricians and surgeons are reluctant to use analgesics in children with acute abdominal pain for the fear of masking symptoms and delaying a possible diagnosis of appendicitis. Over the past few years this traditional belief has been challenged, after the publication of several controlled trials performed on adult patients, showing that early analgesia in this context is safe. Objective We systematically reviewed the literature, searching which is the best available evidence for effectiveness and safety of analgesics in paediatric patients with abdominal pain. Data Sources Medline, Embase, Cochrane Register of Controlled Trials. Results Three double blind Randomized Controlled Trials comparing opioids with placebo were retrieved. The overall methodological quality of these studies was good. With active treatment there was a greater decrease in pain score, with no delay in surgical intervention and no significant change in the ability of physicians of making a correct diagnosis. No important complication was eventually documented. A “post hoc” power calculation has shown that all these trials were not large enough to detect a statistical difference with regard to the main outcomes. Conclusions The use of analgesia effectively reduces the intensity of pain in children with acute abdominal pain and does not interfere with diagnostic accuracy. The small sample size of the studies included in our review should however be considered a potential limitation to their results.