Does analgesia mask diagnosis of appendicitis among children?

QUESTION: Can analgesia be given safely to patients with suspected appendicitis prior to surgical evaluation without masking physical signs and symptoms? ANSWER: Withholding analgesia from patients with acute abdominal pain and suspected appendicitis is common. This practice, however, is not supported by published literature. Although a few trials have noted some changes in abdominal examination with analgesia, this has not been associated with any changes in patient outcome. If patients are in pain, analgesia is warranted. Larger multicentre trials are needed to establish practice guidelines.