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Three Part Question

In [blunt abdominal trauma patients] is [morphine better than pethidine] at [providing pain relief]?

Clinical Scenario

A 34-year old male pedestrian presents to the accident and emergency department after being involved in a vehicle vs. pedestrian event. He is haemodynamically stable, and complains of diffuse abdominal pain. Which analgesic should be prescribed in order to provide the best pain relief?

Search Strategy

MEDLINE 1966- June week 3 2006 using the OVID, EMBASE AND CINAHL interfaces.
{[exp Multiple Trauma OR exp Child OR exp Middle Aged OR exp Accidents, Traffic OR exp Adult OR exp Appendicitis OR exp Wounds, Nonpenetrating OR exp Tomography, X-Ray Computed OR exp Abdominal Injuries OR exp Adolescent OR exp Pancreas/ OR exp Hospitalization OR exp Pancreatic Neoplasms OR exp Abdomen OR exp Liver Neoplasms OR exp Abdominal Injuries OR exp Abdomen Acute OR exp Gastrointestinal Diseases] AND [exp Morphine OR exp Morphine DerivativeS OR exp Meperidine] AND [exp Double-Blind Method OR exp Clinical Trials OR exp Cohort Studies] AND [exp Analgesia]} LIMIT to human AND english

Search Outcome

OVID Medline yielded 344, of which none were relevant to the three part question.
EMBASE yielded 124 papers, of which none were relevant to the three part question

Comment(s)

Although no papers specifically related to the three part question, one PRCT compared the efficacies of morphine and pethidine in postoperative pain. It discovered that morphine was better at relieving pain on sitting (p=0.037), but not at rest (p=0.8). Pethidine was associated with additional side effects (reduced ability to concentrate, dry mouth). The authors concluded that pethidine should be reserved for patients in whom morphine is judged inappropriate. Plummer J.L. Owen H. Ilsley A.H. Inglis S. Anesthesia & Analgesia. 84(4):794-9, 1997 Apr.

Clinical Bottom Line

Not enough evidence exists to support the use of morphine over pethidine in the setting of blunt abdominal trauma.