Ulus Travma Acil Cerrahi Derg. 2012; 18(5): 397-404 | DOI: 10.5505/tjtes.2012.62534

Akut karýn aðrýsý olan yaþlý hastalarda morfinin randomize kontrollü bir çalýþmasý

Faruk Güngör¹, Mutlu Kartal², Fýrat Bektaþ², Secgin Söyüncü², Özlem Yiðit², Ayhan Mesci^3
1Department Of Emergency Medicine, Antalya Training And Research Hospital, Antalya
²Epartments Of Emergency Medicine, Akdeniz University Faculty Of Medicine, Antalya, Turkey
³Departments Of General Surgery Akdeniz University Faculty Of Medicine, Antalya, Turkey

AMAÇ
Bu çalýþmanýn amacý, morfin ve plasebo gruplarýndaki klinik olarak önemli tanýsal doðruluk ve fizik muayenedeki deðiþiklikleri belirlemektir.
GEREÇ VE YÖNTEM
Hastalar 1: 1 oranýnda kör olarak morfin veya plasebo almak için randomize edildi. Çalýþmanýn birincil takip verisi, morfin ve plasebo gruplarýndaki tanýsal doðruluk ve fiziksel incelemede klinik olarak önemli deðiþiklikler olup olmadýðýný belirlemektir.
BULGULAR
Seksen hasta (39 morfin ve 41 plasebo) çalýþmaya dahil edildi. Klinik olarak önemli tanýsal doðruluk oraný morfin grubunda %80 (31/39), plasebo grubunda %78 (32/41) ve %2’lik bir fark oraný saptandý (güven aralýðý [GA] %95, -7% ile 13%, p=0,9802). Morfin grubundaki hastalarýn tüm fiziksel inceleme bulgularý içinde sadece abdominal rijidite bulgusunda (%15) istatistiksel olarak anlamlý deðiþiklik saptandý, ancak plasebo grubunda herhangi bir deðiþiklik (%0) yoktu. Ýki grup arasýndaki fark anlamlý idi (GA %95, %2.3 ile %30.5, p=0.031).
SONUÇ
Bu çalýþma ile acil serviste opioid analjezi uygulanmasýnýn güvenli olduðu ve akut nonspesifik karýn aðrýsý olan yaþlý hastalarda klinik olarak önemli tanýsal deðiþikliðe neden olmadýðý, fakat hastalarda abdominal rijidite gibi önemli fiziksel inceleme bulgularýný deðiþtirebileceði sonucuna varýlmýþtýr.

Anahtar Kelimeler: Analjezi/aðrý kontrolü, klinik deðerlendirme; acil servis.

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Randomized controlled trial of morphine in elderly patients with acute abdominal pain

Faruk Güngör¹, Mutlu Kartal², Fýrat Bektaþ², Secgin Söyüncü², Özlem Yiðit², Ayhan Mesci^3
1Antalya Eðitim Araþtýrma Hastanesi Acil Týp Kliniði
²Akdeniz Üniversitesi Týp Fakültesi Acil Týp Anabilim Dalý
³Akdeniz Üniversitesi Týp Fakültesi Genel Cerrahi Anabilim Dalý

BACKGROUND
The objective of this study was to determine the clinically important change in diagnostic accuracy and physical examination in the morphine vs. placebo group.
METHODS
Subjects were randomized in a 1: 1 ratio to receive a single dose intravenous morphine or placebo in a blinded fashion. Primary outcome measure was to determine if there was a clinically important change in diagnostic accuracy and physical examination in the morphine vs. placebo group.
RESULTS
80 subjects (39 were assigned to morphine and 41 to placebo) were included in the final analysis. Clinically important diagnostic accuracy rate was found to be 80% in the morphine group (31/39) and 78% in the placebo group (32/41), with a difference rate of 2% (95% CI -7% to 13%, p=0.9802. There was a statistically significant change in abdominal rigidity finding (15%) in morphine group in all of the abdominal physical examinations findings; however there was no change in placebo group (0%). The difference between two groups was also statistically significant (95% CI 2.3% to 30.5%, p= 0.031).
CONCLUSION
Administration of opioid analgesia is safe and does not seem to impair clinical diagnostic accuracy in elderly patients with acute undifferentiated abdominal pain. Nevermore, opioids may change the physical examination findings such as abdominal rigidity.

Keywords: Analgesia/pain control, clinical assessment; emergency departments.

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ATIF KOPYALA