Neuroleptanalgesia for acute abdominal pain: a systematic review

ECU Author/Contributor (non-ECU co-authors, if there are any, appear on document)

Andrew C,Khan,Abbas M,Bigalli,Alberto A Castro,Sewell,Ker Miller (Creator)

Institution

East Carolina University (ECU )

Web Site: http://www.ecu.edu/lib/

Abstract: Background: Acute abdominal pain (AAP) comprises up to 10% of all emergency department (ED) visits. Current pain management practice is moving toward multi-modal analgesiaregimens that decrease opioid use.Objective: This project sought to determine whether, in patients with AAP (population), doesadministration of butyrophenone antipsychotics (intervention) compared to placebo, usual care,or opiates alone (comparisons) improve analgesia or decrease opiate consumption (outcomes)?Methods: A structured search was performed in Cochrane CENTRAL, CINAHL, Database ofAbstracts of Reviews of Effects, Directory of Open Access Journals, Embase, IEEE-Xplorer,Latin American and Caribbean Health Sciences Literature, Magiran, PubMed, Scientific Information Database, Scopus, TÜBİTAK ULAKBİM, and Web of Science. Clinical trial registries(ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform,and Australian New Zealand Clinical Trials Registry), relevant bibliographies, and conferenceproceedings were also searched. Searches were not limited by date, language, or publicationstatus. Studies eligible for inclusion were prospective randomized clinical trials enrollingpatients (age ≥18 years) with AAP treated in acute care environments (ED, intensive care unit,postoperative). The butyrophenone must have been administered either intravenously or intramuscularly. Comparison groups included placebo, opiate only, corticosteroids, non-steroidalanti-inflammatory drugs, or acetaminophen.Results: We identified 7,217 references. Six studies met inclusion criteria. One study assessedED patients with AAP associated with gastroparesis, whereas five studies assessed patients withpostoperative AAP: abdominal hysterectomy (n=4), sleeve gastrectomy (n=1). Three of four studiesfound improvements in pain intensity with butyrophenone use. Three of five studies reported nochange in postoperative opiate consumption, while two reported a decrease. One ED study reportedno change in patient satisfaction, while one postoperative study reported improved satisfactionscores. Both extrapyramidal side effects (n=3) and sedation (n=3) were reported as unchanged.Conclusion: Based on available evidence, we cannot draw a conclusion on the efficacy orbenefit of neuroleptanalgesia in the management of patients with AAP. However, preliminarydata suggest that it may improve analgesia and decrease opiate consumption.

Additional Information

Publication

Other

Language: English

Date: 2019

Keywords

neuroleptanalgesia, butryophenone, abdominal pain, haloperidol, droperidol

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