The impact of analgesia on the diagnostic accuracy of the sonographic Murphy's sign

摘要

Objectives Administering analgesia to patients with abdominal pain before diagnostic imaging is now accepted as standard practice. However, analgesia before diagnostic right upper quadrant ultrasound continues to be controversial for fear of masking the sonographic Murphy's sign (SMS). This study sought to evaluate the impact of analgesia on the accuracy of the SMS in predicting cholecystitis. We hypothesized that the impact of analgesia on radiologist-performed ultrasound and emergency physician (EP)-performed ultrasound would be equivalent.Methods Thirty patients presenting to the emergency department with abdominal pain were randomized to receive placebo or meperidine for the first two doses of medication. The patients underwent EP performed right upper quadrant ultrasound before and after the administration of medication, in addition to receiving a radiology department ultrasound postmedication. The presence of SMS was then compared with final hospital or pathological diagnosis.