Bulletin of Emergency And Trauma

The Effects of Intravenous Acetaminophen on Pain and Clinical Findings of Patients with Acute Appendicitis; A Randomized Clinical Trial

Authors

Seyed Mohsen Mousavi 1
Shahram Paydar 2
Sedigheh Tahmasebi 3
Leila Ghahramani 3

1 Trauma Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran

2 Trauma Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.

3 Department of Surgery, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.

Abstract
Objective: To determine the effects of intravenous Acetaminophen (Apotel®)  on pain severity and clinical findings of peritonitis in patients with acute appendicitis.Methods: This randomized  cross-over clinical trial was carried out duringa 6-month  period from August 2012 to February 2013 and comprised 107 patients diagnosed with acute appendicitis. Patients were randomly assigned to received placebo (n=) or Apotel® (n=). Patients were evaluated before, 30 minutes, 1 hour and 4 hours after administration  of Apotel®  or placebo,and were told to fill in two forms. The first form required patientsto measure their painintensityaccording to visual analogue scale (VAS). The second form was filled by a surgeon who examined the patients and recorded his or her findings using Alvarado score criteria for diagnosis of acute appendicitis at foregoing time points.Results: Of 72 patients, 37 (51.4%) were men and 35 (48.6%) were women. The mean age of the patients was 34.1±13.5 years. The mean pain score in 107 patients included in this study was 7.96±2.3. Those who received Apotel®  had significantly lower pain scores when compared to placebo at 30 minutes (p<0.001), 1 hour (p<0.001) and 4 hours of administration. There was no significant difference between two study groups regarding the frequency of Alvarado score; however the frequency of fever was significantly lower in those who received Apotel® (p<0.001). We found that Apotel® was not associated with resolved physical findings of acute appendicitis in different time intervals.Conclusion: Apotel® does not affect the clinical findings of acute appendicitis and dos not interfere with the accurate diagnosis. Therefore, it could safely be used as a reliable pain relieving agent, in patients with acute appendicitis.

Keywords

Acute Appendicitis
Apotel®
Clinical findings
Analgesic
  1. Malik AA, Bari SU. Conservative management of acute appendicitis. J Gastrointest Surg 2009;13(5):966-70.
  2. Yuan Y, Chen JY, Guo H, Zhang Y, Liang DM, Zhou D, et al. Relief of abdominal pain by morphine without altering physical signs in acute appendicitis. Chin Med J (Engl) 2010;123(2):142-5.
  3. Amoli HA, Golozar A, Keshavarzi S, Tavakoli H, Yaghoobi A. Morphine analgesia in patients with acute appendicitis: a randomised double- blind clinical trial. Emerg Med J 2008;25(9):586-9.
  4. Aydelotte JD, Collen JF, Martin RR. Analgesic administration prior to surgical evaluation for acute appendicitis. Curr Surg 2004;61(4):373-5.
  5. Ranji SR, Goldman LE, Simel DL, Shojania KG. Do opiates affect the clinical evaluation of patients with acute abdominal pain? JAMA 2006;296(14):1764-74.
  6. Kokki H, Lintula H, Vanamo K, Heiskanen M, Eskelinen M. Oxycodone vs placebo in children with undifferentiated abdominal pain: a randomized, double-blind clinical trial of the effect of analgesia on diagnostic accuracy. Arch Pediatr Adolesc Med 2005;159(4):320-5.
  7. Bromberg R, Goldman RD. Does analgesia mask diagnosis of appendicitis among children? Can Fam Physician 2007;53(1):39-41.
  8. Armstrong FD. Analgesia for children with acute abdominal pain: a cautious move to improved pain management. Pediatrics 2005;116(4):1018-9.
  9. Mahadevan M, Graff L. Prospective randomized study of analgesic use for ED patients with right lower quadrant abdominal pain. Am J Emerg Med 2000;18(7):753-6.
  10. Marinsek M, Kovacic D, Versnik D, Parasuh M, Golez S, Podbregar M. Analgesic treatment and predictors of satisfaction with analgesia in patients with acute undifferentiated abdominal pain. Eur J Pain 2007;11(7):773-8.
  11. Ayoade BA, Tade AO, Salami BA, Oladapo O. Administration of analgesics in patients with acute abdominal pain: a survey of the practice of doctors in a developing country. Int J Emerg Med 2009;2(4):211-5.
  12. Stalnikowicz R, Mahamid R, Kaspi S, Brezis M. Undertreatment of acute pain in the emergency department: a challenge. Int J Qual Health Care 2005;17(2):173-6.
  13. Attard AR, Corlett MJ, Kidner NJ, Leslie AP, Fraser IA. Safety of early pain relief for acute abdominal pain. BMJ 1992;305(6853):554-6.
  14. Thomas SH, Silen W. Effect on diagnostic efficiency of analgesia for undifferentiated abdominal pain. Br J Surg 2003;90(1):5-9.
  15. LoVecchio F, Oster N, Sturmann K, Nelson LS, Flashner S, Finger R. The use of analgesics in patients with acute abdominal pain. J Emerg Med 1997;15(6):775-9.
  16. Thomas SH, Silen W, Cheema F, Reisner A, Aman S, Goldstein JN, et al. Effects of morphine analgesia on diagnostic accuracy in Emergency Department patients with abdominal pain: a prospective, randomized trial. J Am Coll Surg 2003;196(1):18-31.
Bulletin of Emergency And Trauma
Volume 2, Issue 1 - Serial Number 1
6
Winter 2014
Pages 22-26

  • Receive Date 04 August 2013
  • Accept Date 09 March 2019

Home

Guide for Authors

Publication Fee

Submit Manuscript

Forms

Guide for Reviewers

Contact Us