疼痛控制不影帶兒童盲腸炎的診斷

Pain control will not affect the diagnosis of appendicitis in children

傅統的外科診療指引反對哈急性腹痛崽者鎮痛，直到建立了一個明確的治療計晝。然而，有越來越多的文獻證據顯示，早期鎮痛不會影響成人患者腹痛診斷或決策的準確性。對於兒童來說，支持這個研究的文獻數量有限。我們是透過PUBMED搜索引擎和OVID搜索引擎進行了英語文獻搜索。使用下列醫學主題詞和關鍵詞進行搜索：腹痛或闌尾炎和鎮痛藥或鴉片類藥物和兒童。文獻的檢索顯示四篇隨機和對照試驗文獻。所有研究都使用視覺類比量表。總體而言，鎮痛組是有顯著減少疼痛。Kim等人顯示出靜脈注射嗎啡組的觸痛的區域或診斷的準確性沒有顯著變化。Green等人表明使用嗎啡沒有增加誤診闌尾炎的診斷率，和穿孔闌尾炎率不受使用嗎啡的影響，而使用嗎啡顯著降低疼痛評分。Kokki等人發現在鴉片類藥物和安慰劑組間的延遲戎不必要的手術率無差異。Bailey等人表明兒童疑似闌尾炎患者使用嗎啡並沒耽誤手術的決定。這些系統性審查研究和額外的回顧性研究文獻明確地支持，鴉片類鎮痛藥物可以在急性腹痛懷疑闌尾炎再充分評估和診斷之前被安全地給予，而不會增加錯誤診斷或治療的風險。

Traditional surgical practice recommended against giving analgesia to patients with acute abdominal pain until a definite treatment plan was established. However, there is increasing evidence from current literature that early analgesia does not adversely affect the accuracy of the diagnosis or decision-making in adults with abdominal pain. For children, there are still a limited number of studies to support this. A search for English language literatures in October 2014 was conducted via PUBMED search engine and OVID search engine. The search was conducted using the following medical subject headings and key words: abdominal pain or appendicitis and analgesics or opioid and children. References were cross¬ checked for additional studies not found in the searched database. The search of literature revealed four randomized and control trials. All studies used a 10cm Visual Analogue Scale to access pain. Overall, the analgesia group was associated with significant reduction in pain. Kim et al. showed no significant change in the area of tenderness or in the diagnostic accuracy with the intravenous morphine group. Green et al. showed morphine administration did not increase the rate of missed appendicitis, and the rate of perforated appendicitis was unaffected by the treatment of morphine, while morphine was found to decrease pain score significantly. Kokki et al. found no difference in the rate of delayed or unnecessary surgery between opioid and placebo groups. Bailey et al. showed the use of morphine in children with suspected appendicitis did not delay the surgical decision. These systemic reviews, and together with additional retrospective studies of available literature clearly support that opioid analgesics can be safely given before full assessmentand diagnosis in acute abdomen pain suspecting appendicitis, without increasing the risk of errors in diagnosis or treatment.