Analgesic administration prior to surgical evaluation for acute appendicitis

The attitudes of surgeons and nonsurgeons regarding the administration of pain medicine prior to arriving at a surgical diagnosis are changing. It is common practice to administer narcotic analgesics prior to a general surgeon's evaluation. Several studies have advocated the safety of this practice in the emergency department. Many of these studies are flawed by inclusion of many patients who did not have a surgical illness. Our study examined the practice of narcotic administration in patients determined to have appendicitis who underwent operation.

We retrospectively reviewed 75 consecutive appendectomies. Emergency department records and in-patient charts were reviewed to assess differences in 2 groups of patients: those who received narcotic pain medicine and those who did not. Specific outcome parameters were reviewed such as time in hospital, time to the operating room, and complication rate. We also created a scoring system for the physical examination to attempt to quantify a difference between the groups.

Overall, 75 patient charts were reviewed. Nine patients were excluded. There was no statistically significant difference in the 2 groups in regard to time in hospital, time to operation, complication rate, perforation rate, or negative appendectomy rate. The physical examination scoring system did show a difference between those who got pain medicine and those who did not, but failed to show a difference between examiners after pain medicine was given.

There does not appear to be a difference in hospital stay, time to the operating room, complication rate, negative appendectomy rate, or perforation rate in patients who received pain medicine prior to a surgeon's evaluation and those who did not in this retrospective review.