CHAPTER 66 MORPHINE AND THE CLINICAL ABDOMINAL EXAM

Randomized Clinical Trial of Morphine in Acute Abdominal Pain

Gallagher EJ, Esses D, Lee C, Lahn M, Bijur PE. Ann Emerg Med. 2006;48:150–160

BACKGROUND

Acute abdominal pain is the most common presenting complaint in EDs nationwide, accounting for more than 7 million visits annually. When encountered in the ED, a commonly heard phrase is “don’t give opiates, it ruins the abdominal exam.” For many years there had been conflicting consensus recommendations and a paucity of studies exploring the effect of treating acute abdominal pain in the ED with opiates. As such, many physicians were reluctant to treat pain due to the possibility of obscuring the diagnosis.

OBJECTIVES

To test the hypothesis that IV morphine given in the ED will improve, rather than diminish, diagnostic accuracy while simultaneously reducing patient discomfort.

METHODS

Randomized double-blind study in a US ED between 2002 and 2004.

Patients

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