What is the role of medications in the ED treatment of abdominal pain in elderly persons?

Updated: Jul 17, 2018
  • Author: E David Bryan, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

In patients with undifferentiated abdominal pain, administering small doses of opioids is reasonable. Several studies have demonstrated this to be safe and effective without decreasing diagnostic accuracy. Consider the following:

  • Morphine administered IV in doses of 2-4 mg is inexpensive and effective. Morphine, like all opioid analgesics, has been demonstrated to cause spasm of the sphincter of Oddi. This side effect should be taken into account when treating patients in whom biliary disease is suspected.

  • Fentanyl has distinct advantages for use in the emergency department. Its short half-life allows for frequent reevaluations between doses. It also causes almost no increase in histamine release and minimal drop in blood pressure.

  • Meperidine (Demerol) has been the traditional opioid of choice in biliary tract disease because it causes less sphincter of Oddi spasm. However, the incidence of adverse central nervous system effects, including seizures, have led many to caution against its use under any circumstance.

  • Depending on the practice environment, contacting the on-call surgeon prior to administering opioids may be reasonable.

Initiate appropriate antibiotic coverage for patients in whom sepsis, cholecystitis, appendicitis, diverticulitis, or perforated viscus is suspected. Please refer to the article on the specific diagnosis for choice of antibiotics for a specific disease process (see Differentials).


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