Safety and effectiveness of opioid analgesia for acute appendicitis in the emergency department:meta-analysis

LU Kui; XU Yu-qiong; TAN Xin-yu; TAN Du-xun; TONG Hua-sheng; SU Lei

doi:10.3969/j.issn.1002-1949.2016.07.016

Abstract：Objective To evaluate the effectiveness and safety of opioid analgesia for suspected acute appendicitis ( AA) in the emergency department ( ED).Methods Randomized controlled trials ( RCTs ) on opioid analgesia for AA in ED were searched in The Cochrane Library , MEDLINE, EMbase, VIP, CNKI, CBMdisc and other electronic databases .The quality of RCTs meeting inclusion criteria was evaluated and the data were extracted; meta-analyses were performed with STATA 13.1 software.Results Among the 8 RCTs involving 1065 cases included, 1053 cases met the inclusion criteria .Meta-analyses showed that:compared with a placebo , opioid analgesia could decrease significantly in the pre/post difference in self -reported pain scores ( SMD=0.58, 95%CI:0. 39 to 0.76, P<0.00001), the rate of appendectomy lowered significantly (RR=1.09, 95%CI:1.01 to 1.19, P=0.04) following analgesia.There were no significant differences between the two groups in the rates of histologically proven AA (RR =1.13, 95%CI: 0.99 to 1.28, P =0.07), perforated appendices(RR=0.96, 95%CI:0.63 to 1.54, P=0.93),missed appendicitis (RR=0.50, 95%CI:0.09 to 2.64, P=0.41)and side effects related to the analgesic (RR=6.91, 95%CI:0.87to 54.75, P=0.07).Conclusion The present results of clinical trials show that opioid analgesia for suspected AA in ED is a safe and effective therapy without altering diagnostic accuracy or surgical outcome and increasing the side effects .However , in view of the limitations of this study , it suggests that large -scale, high quality researches on basic and clinical fields should be performed to further verify the above conclusion by critical outcome indicators .