Neuroleptanalgesia for acute abdominal pain: a systematic review

Andrew C Miller,1,2 Abbas M Khan,2 Alberto A Castro Bigalli,3 Kerry A Sewell,4 Alexandra R King,5 Shadi Ghadermarzi,6 Yuxuan Mao,6 Shahriar Zehtabchi7 1Department of Emergency Medicine, Vidant Medical Center, Brody School of Medicine, East Carolina University, Greenville, NC, USA; 2The MORZAK Collaborative, Orlando, FL, USA; 3Brody School of Medicine, East Carolina University, Greenville, NC, USA; 4William E. Laupus Health Sciences Library, East Carolina University, Greenville, NC, USA; 5Division of Emergency Medicine and Toxicology, Department of Pharmacy, Vidant Medical Center, Greenville, NC, USA; 6Department of Internal Medicine, Vidant Medical Center, East Carolina University Brody School of Medicine, Greenville, NC, USA; 7Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA Background: Acute abdominal pain (AAP) comprises up to 10% of all emergency department (ED) visits. Current pain management practice is moving toward multi-modal analgesia regimens that decrease opioid use. Objective: This project sought to determine whether, in patients with AAP (population), does administration 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 of Abstracts 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 conference proceedings were also searched. Searches were not limited by date, language, or publication status. Studies eligible for inclusion were prospective randomized clinical trials enrolling patients (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-steroidal anti-inflammatory drugs, or acetaminophen. Results: We identified 7,217 references. Six studies met inclusion criteria. One study assessed ED patients with AAP associated with gastroparesis, whereas five studies assessed patients with postoperative AAP: abdominal hysterectomy (n=4), sleeve gastrectomy (n=1). Three of four studies found improvements in pain intensity with butyrophenone use. Three of five studies reported no change in postoperative opiate consumption, while two reported a decrease. One ED study reported no change in patient satisfaction, while one postoperative study reported improved satisfaction scores. 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 or benefit of neuroleptanalgesia in the management of patients with AAP. However, preliminary data suggest that it may improve analgesia and decrease opiate consumption. Keywords: neuroleptanalgesia, butryophenone, abdominal pain, haloperidol, droperidol