J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 11, Number 2, February 2019, pages 121-126

To Use or Not to Use Opioid Analgesia for Acute Abdominal Pain Before Definitive Surgical Diagnosis? A Systematic Review and Network Meta-Analysis

Figure 3. Plot showing (a) evidence of treatment approaches and (b) direct and indirect evidence of the treatment approaches. PL, placebo; MR, morphine; TR, tramadol; PV, papaveretum; PTH, pethidine.

**Table 1.** : Study Characteristics and Risk of Bias
Author	Number of patients OA - PL	Age OA - PL, mean, SD	Type of opioid	Random sequence generation	Allocation concealment	Blinding of participants and personnel	Blinding of outcome assessment
OA: opioid analgesia; PL: placebo; SD: standard deviation.
Attard, 1992, UK	50 - 50	Over 16	Papaveretum 20 mg	High risk	Unclear	High risk	High risk
Pace, 1996, USA	35 - 36	Over 18 44 ± 19 - 41 ± 18 P = 0.496	Morphine 10 mg	Low risk	Unclear	Low risk	High risk
LoVecchio, 1997, USA	22 - 16	Over 18	Morphine 5 or 10 mg	Low risk	High risk	Low risk	High risk
Vermulen, 1999, Switzerland	175 - 165	Over 16	Morphine 10 mg	High risk	High risk	High risk	High risk
Mahadevan, 2000, Singapore	33 - 33	Over 16 27 ± 11 - 29 ± 13 P = 0.502	Tramadol 1 mg/kg	Low risk	Low risk	Unclear	Unclear
Thomas, 2003, USA	38 - 36	Over 18 39 ± 4.5 - 39 ± 6.5 P = 1.00	Morphine 15 mg	Unclear	High risk	High risk	Low risk
Gallagher, 2006, USA	78 - 75	Over 21 47 ± 17 - 45 ± 17 P = 0.468	Morphine 0.1 mg/kg	Low risk	Low risk	Low risk	Low risk
Amoli, 2008, Iran	35 - 36	Over 14 26.7 ± 10 - 23.9 ± 7 P = 0.175	Morphine 0.1 mg/kg	Low risk	Low risk	Low risk	Low risk
Amini, 2012, Iran	53 - 53	Over 16 30 ± 10 - 29 ± 10 P =0.608	Pethidine 1 mg/kg	High risk	High risk	High risk	High risk
Güngör, 2012, Turkey	39 - 41	Over 21 73 ± 7 - 73 ± 8 P = 1.00	Morphine 0.1 mg/kg	High risk	High risk	Unclear	Low risk
Aghamohammadi 2012, Iran	60 - 60	Over 12 31 ± 10 - 35 ± 10 P = 0.054	Morphine 0.1 mg/kg	Low risk	Low risk	Low risk	Unclear
Agodirin, 2013, Nigeria	46 - 49	Over 18	Tramadol 100 mg	Low risk	Low risk	Low risk	High risk
Pooled differences	664 - 650 total 1,314	OR = 0.09 (-1.31, 1.48), P = 0.90, I² = 5%		Low risk seven studies	Low risk five studies	Low risk six studies	Low risk four studies

Table 1. : Study Characteristics and Risk of Bias

Author

Number of patients OA - PL

Age OA - PL, mean, SD

Type of opioid

Random sequence generation

Allocation concealment

Blinding of participants and personnel

Blinding of outcome assessment

OA: opioid analgesia; PL: placebo; SD: standard deviation.

Attard, 1992, UK

50 - 50

Over 16

Papaveretum 20 mg

High risk

Unclear

High risk

Pace, 1996, USA

35 - 36

Over 18
44 ± 19 - 41 ± 18
P = 0.496

Morphine 10 mg

Low risk

Unclear

Low risk

High risk

LoVecchio, 1997, USA

22 - 16

Over 18

Morphine 5 or 10 mg

Low risk

High risk

Low risk

High risk

Vermulen, 1999, Switzerland

175 - 165

Over 16

Morphine 10 mg

High risk

Mahadevan, 2000, Singapore

33 - 33

Over 16
27 ± 11 - 29 ± 13
P = 0.502

Tramadol 1 mg/kg

Low risk

Unclear

Thomas, 2003, USA

38 - 36

Over 18
39 ± 4.5 - 39 ± 6.5
P = 1.00

Morphine 15 mg

Unclear

High risk

Low risk

Gallagher, 2006, USA

78 - 75

Over 21
47 ± 17 - 45 ± 17
P = 0.468

Morphine 0.1 mg/kg

Low risk

Amoli, 2008, Iran

35 - 36

Over 14
26.7 ± 10 - 23.9 ± 7
P = 0.175

Morphine 0.1 mg/kg

Low risk

Amini, 2012, Iran

53 - 53

Over 16
30 ± 10 - 29 ± 10
P =0.608

Pethidine 1 mg/kg

High risk

Güngör, 2012, Turkey

39 - 41

Over 21
73 ± 7 - 73 ± 8
P = 1.00

Morphine 0.1 mg/kg

High risk

Unclear

Low risk

Aghamohammadi
2012, Iran

60 - 60

Over 12
31 ± 10 - 35 ± 10
P = 0.054

Morphine 0.1 mg/kg

Low risk

Unclear

Agodirin, 2013, Nigeria

46 - 49

Over 18

Tramadol 100 mg

Low risk

High risk

Pooled differences

664 - 650
total 1,314

OR = 0.09 (-1.31, 1.48), P = 0.90, I² = 5%

Low risk seven studies

Low risk five studies

Low risk six studies

Low risk four studies