Pentazocine, a Kappa-Opioid Agonist, Is Better Than Diclofenac for Analgesia in Acute Pancreatitis: A Randomized Controlled Trial

Abstract

OBJECTIVES: The ideal analgesic is not known for patients with acute pancreatitis (AP). Concerns have been raised about serious adverse effects of opioid analgesics increasing the severity of AP. We hypothesized that nonsteroidal anti-inflammatory drugs might be better analgesics because of their anti-inflammatory effect. Our objective was to compare pentazocine, an opioid, and diclofenac, a nonsteroidal anti-inflammatory drug, for adequate analgesia in patients with AP. METHODS: In a double-blind randomized controlled trial, patients with AP were randomized to either intravenous diclofenac 75 mg or pentazocine 30 mg. Fentanyl was given as a rescue analgesic through a patient-controlled analgesia pump. Primary outcome was pain relief measured objectively by the dose of fentanyl required as the rescue analgesic, pain-free period, and numbers of effective and ineffective demands of fentanyl. Secondary outcome was adverse events. RESULTS: Fifty patients were randomized, 24 to the pentazocine group and 26 to the diclofenac group. Baseline characteristics were comparable between the groups. Pentazocine was found to be better than diclofenac in terms of significantly lower dose of the rescue analgesic (fentanyl) required (126 μg (interquartile range (IQR) 65–218 μg) vs 225.5 μg (IQR 133–427 μg); P = 0.028) and longer pain-free period (31.1 ± 8.2 vs 27.9 ± 6.6 hours, P = 0.047). The number of effective and ineffective demands was lower in the pentazocine group compared with the diclofenac group (11.5 (IQR 8–15) vs 16 (IQR 13–20), P = 0.098) although not statistically significant. Adverse events were similar between the groups. CONCLUSIONS: Pentazocine, a kappa-opioid receptor agonist, was significantly better than diclofenac for pain relief in AP (Trial registration number: CTRI/2016/09/007326).

Comparison of efficacy of diclofenac and tramadol in relieving pain in patients of acute pancreatitis: A randomized parallel group double blind active controlled pilot study

“…Opioids are reported to decrease the need of supplementary analgesia ( n = 162, 3 studies) in acute pancreatitis highlighting their efficacy (Basurto Ona et al, ). In a recently published study, pentazocine was found to be more effective than diclofenac in patients of AP by providing longer pain free intervals and decreased need for rescue analgesia (Mahapatra et al, ). In our study, although tramadol decreased the need of supplementary analgesia (40% in diclofenac group vs. 25% in tramadol group), the difference was not statistically significant.…”

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

“…A PRISMA flow diagram for study selection is shown in Figure 1. A total of 12 studies (33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) were included. Study design and quality assessment are displayed in Table 2 and a detailed Jadad scoring is shown in Supplementary Table 1.…”

“…A total of 800 patients with AP were screened and 699 were analysed with age ranged from 23 to 86 years old. Gender was reported in 11 studies (34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44). Two studies (39,40) reported the weight and 3 studies (35-37) reported body mass index.…”

“…Two studies (39,40) reported the weight and 3 studies (35-37) reported body mass index. Ten studies (34)(35)(36)(37)(38)(39)(40)(41)(42)(43) reported aetiology of AP. Regarding AP severity classification, 2 studies (38,44) did not report data on AP severity, 2 studies (35,37) reported substantial proportion of patients with severe AP, and the remaining 8 studies (33,34,36,(39)(40)(41)(42)(43) mainly included patients with mild AP.…”

“…Ten studies (33)(34)(35)(36)(37)(38)(39)(40)(41)43) were used the VAS to assess pain intensity, with VAS (0-100) in 6 studies (36,(38)(39)(40)(41)43) and VAS (0-10) in 4 studies (33)(34)(35)37). One study (44) employed verbal self-report scale (0-5) for pain assessment and one (42) did not score pain. Study duration ranged from.5 h to 7 days.…”