Administration of analgesics in patients with acute abdominal pain: a survey of the practice of doctors in a developing country

Background

Analgesic use, particularly opioids in the emergency situation in patients with acute abdominal pain, generally has been avoided in the past; however, newer evidence has shown that the practice should be encouraged. In spite of this, many physicians still withhold analgesics in this clinical situation.

Aims

The aim of the study was to evaluate the current opinion and practice of Nigerian doctors regarding the use of analgesics for patients with acute abdominal pain during the initial evaluation.

Methods

A one-page survey was distributed by two of the authors to Nigerian doctors from different parts of the country during conferences, seminars and meetings on different occasions in 2007. Demographic data and information regarding medical specialty, post-qualification experience, analgesic use in acute abdominal pain, and effects on diagnosis and outcome were included. The respondents were then classed into two sets of two groups using specialty (surgical and non-surgical) and post-qualification experience (less than 10 years, “less experienced;” over 10 years, “experienced”).

Results

There were 539 respondents. The male:female ratio was 12:1. Of the respondents, 50.4% would withhold analgesics if the diagnosis was unclear, and a further 12% would do the same if a surgical opinion was required. Reasons for withholding analgesics were (1) believing that analgesics interfered with evolution of signs (84.4%), (2) believing that the diagnosis would be impaired (77.9%) and (3) believing that analgesics would have an adverse effect on outcome (54.5%). Specialty or length of post-qualification experience did not significantly influence this practice (p < 0.05).

Conclusion

The study has shown that the dogma that analgesics are harmful in patients with acute abdominal pain is still firmly entrenched in the practice of the surveyed Nigerian doctors. This belief is not significantly affected by specialty or post-qualification experience.