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A randomized clinical trial of analgesia in children with acute abdominal pain
Michael K Kim1, Richard T Strait, Thomas T Sato
1Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI 53226-0509, USA. mkim@mcw.edu
Insights
Intravenous morphine significantly reduces pain in children with acute abdominal pain. This effective pain management does not hinder physical examinations or the accurate diagnosis of surgical conditions in pediatric patients.
Area of Science:
- Pediatric Emergency Medicine
- Pain Management
- Surgical Evaluation
Background:
- Acute abdominal pain is a common reason for pediatric emergency department visits.
- Effective pain management is crucial, but concerns exist regarding its impact on clinical assessment and diagnosis.
Purpose of the Study:
- To assess the efficacy of intravenous morphine in reducing pain in children with acute abdominal pain.
- To determine if morphine affects physical examination findings and diagnostic accuracy.
Main Methods:
- A randomized, double-blind, placebo-controlled trial involving children aged 5-18 with severe abdominal pain.
- Patients received either morphine (0.1 mg/kg) or saline, with assessments before and after medication.
Main Results:
- Morphine administration resulted in a statistically significant reduction in pain scores (p = 0.002).
- No significant changes were observed in physical examination findings (tenderness) or diagnostic accuracy between groups.
- Children with surgical conditions consistently showed persistent tenderness.
Conclusions:
- Intravenous morphine is effective for pain relief in pediatric acute abdominal pain.
- Morphine administration does not compromise the physical examination or the identification of surgical emergencies in children.
Objective:
To evaluate the effects of intravenous morphine on pain reduction, physical examination, and diagnostic accuracy in children with acute abdominal pain.
Methods:
A randomized, double-blind, placebo-controlled clinical trial was conducted at an emergency department of a tertiary care children's hospital. Children aged 5-18 years with abdominal pain of < or =5 days' duration, pain score > or =5 on a 0-10 visual analog scale, and need for surgical evaluation were eligible. Following the initial assessment, patients were randomized to receive either 0.1 mg/kg morphine or an equal volume of saline. The pediatric emergency medicine physician and surgical consultant independently recorded the areas of tenderness to palpation and percussion, and their diagnoses before the study medication and 15 to 30 minutes later.
Results:
Sixty patients were enrolled, and 29 received morphine and 31 received saline. The demographic characteristics between the two groups were similar. The median reduction of pain score between the two study groups was 2 (95% CI = 1 to 4; p = 0.002). There was no significant change in the areas of tenderness in both study groups. Children with surgical conditions had persistent tenderness to palpation and/or percussion. There was no significant change in the diagnostic accuracy between the study groups and between the physician groups. All patients requiring laparotomy were identified and no significant complication was noted in the morphine group.
Conclusions:
Intravenous morphine provides significant pain reduction to children with acute abdominal pain without adversely affecting the examination, and morphine does not affect the ability to identify children with surgical conditions.