Pain Management in Acute Pancreatitis

Schorn, Stefan; Ceyhan, Güralp O.; Tieftrunk, Elke; Friess, Helmut; Demir, Ihsan Ekin

doi:10.3998/panc.2015.15

Cited by 8 publications

(2 citation statements)

References 82 publications

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“…It is usually constant and described as deep and penetrating, due probably to retroperitoneal localization of pancreas. Pain may be exacerbated by eating, drinking, or lying supine and is often associated with nausea and vomiting [16,17].…”

Section: Pain Controlmentioning

confidence: 99%

The Anesthesiologist Contribution to Management of Acute Pancreatitis

Dotto¹

2023

Multidisciplinary Management of Acute and Chronic Pancreatitis

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Acute pancreatitis is a complex disease, and although most patients have a self-limiting illness, a minority of them develop severe disease and may need Intensive Care Unit admission. Regardless of severity degree, two cornerstones of acute pancreatitis multidisciplinary management are: fluid resuscitation and pain relief. These patients are frequently hypovolemic because of decreased oral intake, vomiting, fever, and fluid sequestration associated with pancreatic and systemic inflammation. Early intravenous volume resuscitation seems to reduce pancreatic hypoperfusion and multiorgan failure, but fluid overload has been associated with worse outcome, and maintaining proper hydration could be challenging. Acute pancreatitis is a very painful condition and effective analgesia is one of the priorities. Pain relief has a positive impact because of reduced stress response, sympathetic-induced vasoconstriction, and pulmonary complications. It is suggested to use a multimodal analgesic approach, to achieve patient’s satisfaction, minimize opioid consumption and side effects. A modern and effective approach involves the use of patient-controlled analgesia and thoracic epidural analgesia. We would revise these two items to offer early and better multidisciplinary management to patients with acute pancreatitis, including those with mild to moderate disease, who are managed in general surgical wards, with the aim to improve their outcome and hospital stay.

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Section: Pain Controlmentioning

confidence: 99%

The Anesthesiologist Contribution to Management of Acute Pancreatitis

Dotto¹

2023

Multidisciplinary Management of Acute and Chronic Pancreatitis

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“…Since abdominal pain in AP is secondary to pancreatic parenchymal inflammation (17,18), non-steroidal anti-inflammatory drugs (NSAIDs) that target the enzyme cyclooxygenase (COX) are often used (19,20). Much less frequently, local anaesthetics (i.e., procaine and bupivacaine) and paracetamol (19)(20)(21) are used.…”

Section: Introductionmentioning

confidence: 99%

Pain Management in Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

et al. 2021

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Background: Pain management is an important priority in the treatment of acute pancreatitis (AP). Current evidence and guideline recommendations are inconsistent on the most effective analgesic protocol. This systematic review and meta-analysis of randomised controlled trials (RCTs) aimed to compare the safety and efficacy of analgesics for pain relief in AP.Methods: A literature search was performed to identify all RCTs assessing analgesics in patients with AP. The primary outcome was the number of participants who needed rescue analgesia. Study quality was assessed using Jadad score. Pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CI) were analysed using a random-effects model.Results: Twelve studies comprising 699 patients with AP (83% mild AP) were analysed. The tested analgesics significantly decreased the need for rescue analgesia (3 studies, OR.36, 95% CI 0.21 to 0.60) vs. placebo or conventional treatment. The analgesics also improved the pain score [Visual Analogue Scale (Δ-VAS)] at 24 h (WMD 18.46, 0.84 to 36.07) and by the 3rd to 7th days (WMD 11.57, 0.87 to 22.28). Opioids vs. non-opioids were associated with a decrease in the need for rescue analgesia (6 studies, OR 0.25, 95% CI 0.07 to 0.86, p = 0.03) but without significance in pain score. In subgroup analyses, opioids were similar to non-steroidal anti-inflammatory drugs (NSAIDs) regarding the primary outcome (4 studies, OR 0.56, 95% CI 0.24 to 1.32, p = 0.18). There were no significant differences in other clinical outcomes and rate of adverse events. Other studies, comparing epidural anaesthesia vs. patient-controlled analgesia and opioid (buprenorphine) vs. opioid (pethidine) did not show significant difference in primary outcome. Study quality issues significantly contributed to overall study heterogeneity.Conclusions: NSAIDs and opioids are equally effective in decreasing the need for rescue analgesia in patients with mild AP. The relative paucity of trials and high-quality data in this setting is notable and the optimal analgesic strategy for patients with moderately severe and severe AP still requires to be determined.

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Prediction of Self-Limited Acute Pancreatitis Cases at Admission to Emergency Unit

Kayar

Şentürk

Tozlu

et al. 2018

GE Port J Gastroenterol

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Background: While acute pancreatitis (AP) resolves spontaneously with supportive treatment in most patients, it may be life-threatening. Predicting the disease severity at onset dictates the management strategy. We aimed to define the patients with mild pancreatitis who may be considered for outpatient management with significant cost-savings. Materials and Methods: This prospective observational study included 180 patients with mild AP according to the harmless acute pancreatitis score (HAPS) and Imrie score. The relationships of biochemical parameters with the changes in the Balthazar score and clinical course were examined. Results: The study included 180 patients (111 females, 69 males; mean age: 53.9 ± 17.2 years; range: 17–92 years). The etiology was biliary in 118 (65%) patients and remained undetermined in 38 (21.1%) patients. Computed tomography (CT) performed within the first 12 h revealed mild and moderate AP in 159 (88.3%) and 21 (11.7%) patients, respectively. CT repeated at 72 h revealed mild, moderate, and severe AP in 155 (86.1%), 24 (13.3%), and 1 (0.6%) patients, respectively. Comparisons between stages A + B + C and D + E showed significant differences in the amylase levels on day 1 and 3, and in C-reactive protein on day 3. Also, in stage D and E disease, narcotic analgesic intake, oral intake onset time, and pain were significantly higher. Conclusion: There were no significant changes in the CT findings of patients with mild AP at 12 and 72 h. Most patients (n = 179; 99.4%) recovered uneventfully. Patients with mild pancreatitis according to the HAPS and Imrie scores can be considered for outpatient management. The recovery is longer in stage D and E disease.

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Pain Management in Acute Pancreatitis

Cited by 8 publications

References 82 publications

The Anesthesiologist Contribution to Management of Acute Pancreatitis

The Anesthesiologist Contribution to Management of Acute Pancreatitis

Pain Management in Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Prediction of Self-Limited Acute Pancreatitis Cases at Admission to Emergency Unit

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