Tramadol Effective for Pain, Does Not Affect Diagnosis in Suspected Appendicitis

The opioid tramadol is an effective analgesic for patients with clinically suspected acute appendicitis, according to the results of a prospective study presented at the 2015 Annual Meeting of the American College of Surgeons (ACS).

“Tramadol…can provide significant reduction in abdominal pain and tenderness without altering the diagnostic confidence of the surgeon…in patients with suspected appendicitis,” explained lead author Johann Paulo Guzman, MD, East Avenue Medical Center, Quezon City, Philippines, speaking at a poster presentation here on October 5.

These findings challenge the current practice of withholding analgesics in patients with acute right lower quadrant pain, thinking that the pain relief could mask physical signs of appendicitis, delaying diagnosis.

Dr. Guzman and colleagues randomised 85 subjects (mean age 37.5 years; predominantly male) with acute onset of right-lower-quadrant abdominal pain to receive either intravenous tramadol 50 mg (n = 47) or placebo (n = 38). The researchers then evaluated subjects using validated abdominal pain and tenderness visual analog scale (VAS) scores compiled during a physical examination. They also assessed the surgeon’s confidence in the diagnosis of acute appendicitis or abdominal pain that did not require surgery.

Mean pain scores were significantly decreased following the administration of tramadol (8.91±1.25 vs 5.56±1.54; P = .02), while the placebo demonstrated no effect (8.76±1.05 vs 8.58±1.18; P = .58). VAS scores of abdominal tenderness similarly decreased following tramadol injection (9.21±0.95 vs 6.15±1.23; P = .02), while placebo had no effect on abdominal tenderness (9.18±0.85 vs 8.87±0.85; P = .12).

Physician confidence in accurately assessing the situation and distinguishing acute appendicitis before and after administration of tramadol was similar whether the patients received the study drug (93.83%±3.79% vs 93.86%±3.86%; P = .73) or placebo (92.89%±5.12% vs 92.91%±5.12%; P = .10). Similar findings were evident in distinguishing a nonsurgical condition before and following tramadol treatment (93.5%±4.49% vs 90.0%±0.00; P = .37) or use of placebo (92.50%±2.78% vs 90.0%±0.00; P = .32).

The findings of a significant effect of tramadol on pain with a lack of influence on the diagnosis suggest that the current dogma of not providing analgesic treatment for patients suspected of acute appendicitis warrants reassessment.

These findings require verification in a larger randomised controlled trial with more statistical rigor, the authors concluded. Subsequent trials must assess side effects, and whether they preclude tramadol therapy for the pain relief of suspected acute appendicitis.