Matthieu Jabaudon1,2, Nouria Belhadj-Tahar3, Thomas Rimmelé4, Olivier Joannes-Boyau5, Stéphanie Bulyez1, Jean-Yves Lefrant6, Yannick Malledant7, Marc Leone8, Paer-Selim Abback9, Fabienne Tamion10, Hervé Dupont11, Brice Lortat-Jacob12, Philippe Guerci13, Thomas Kerforne14, Raphael Cinotti15, Laurent Jacob16, Philippe Verdier17, Thierry Dugernier18, Bruno Pereira19, Jean-Michel Constantin1,2. 1. Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France. 2. Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, GReD, Clermont-Ferrand, France. 3. Department of Anesthesia and Critical Care, Saint-Antoine University Hospital, Assistance Publique-Hôpitaux de Paris, and Sorbonne Universités, UPMC Univ Paris 06, Paris, France. 4. Department of Anesthesiology and Critical Care Medicine, Hôpital Edouard Herriot, CHU Lyon, Lyon, France. 5. Department of Anesthesiology and Critical Care Medicine, Service d'Anesthésie-Réanimation 2, CHU Bordeaux, Bordeaux, France. 6. Division of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, and EA 2992, Université Montpellier, Nîmes, France. 7. Surgical Intensive Care Unit, Hôpital Pontchaillou, and Inserm U 991, Université de Rennes 1, Rennes, France. 8. Intensive Care Unit, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, and UMR 63, CNRS 7278, IRD 198, INSERM U1095, Aix-Marseille Université, Marseille, France. 9. Department of Anesthesiology and Critical Care Medicine, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Paris, France. 10. Surgical Intensive Care Unit, CHU Rouen, and Inserm 1096, IRIB, Université Rouen, Rouen, France. 11. Medical and Surgical ICU, Amiens University Hospital and INSERM U1088, University of Picardy Jules Verne, Amiens, France. 12. Department of Anesthesiology and Critical Care Medicine, CHU Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, and Université Denis Diderot, PRESS Sorbonne Cité, Paris, France. 13. Surgical Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, CHU Nancy, Nancy, France. 14. Emergency Department, CHU Poitiers, and INSERM U1070, Université de Poitiers, Poitiers, France. 15. Department of Anesthesiology and Critical Care Medicine, Hôtel-Dieu, and EA 3826, Université de Nantes, Nantes, France. 16. Department of Anesthesiology and Critical Care Medicine, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France. 17. Intensive Care Unit, CH Montluçon, Montluçon, France. 18. Department of Intensive Care Medicine, Clinique Saint-Pierre, Ottignies, Belgium. 19. Biostatistics Unit, Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France.
Abstract
OBJECTIVE: Recent preclinical and clinical data suggest that thoracic epidural analgesia, a technique primarily aimed at decreasing pain, might exert anti-inflammatory effects, enhance splanchnic and pancreatic blood flow during acute pancreatitis; however, the influence of epidural analgesia on mortality remains under investigated in this setting. This study was therefore designed to assess the impact of epidural analgesia on mortality in ICU patients with acute pancreatitis. DESIGN: Multicenter retrospective, observational, cohort study. SETTING: Seventeen French and Belgian ICUs. PATIENTS: All patients admitted to with acute pancreatitis between June 2009 and March 2014. INTERVENTIONS: The primary exposure was thoracic epidural analgesia versus standard care without epidural analgesia. The primary outcome was 30-day mortality. Propensity analyses were used to control for bias in treatment assignment and prognostic imbalances. MEASUREMENTS AND MAIN RESULTS: One thousand three ICU patients with acute pancreatitis were enrolled, of whom 212 died within 30 days. Epidural analgesia was used in 46 patients and was associated with reduced mortality in unadjusted analyses (4% vs. 22%; p = 0.003). After adjustment for baseline variables associated with mortality, epidural analgesia was still an independent predictor of 30-day mortality (adjusted odds ratio, 0.10; [95% CI, 0.02-0.49]; p = 0.004). Using propensity score analysis, the risk of all-cause 30-day mortality in patients with acute pancreatitis receiving epidural analgesia was significantly lower than that in matched patients who did not receive epidural analgesia (2% vs. 17%; p = 0.01). CONCLUSIONS: Among critically ill patients with acute pancreatitis, mortality at 30 days was lower in patients who received epidural analgesia than in comparable patients who did not. These findings support ongoing research on the use of epidural analgesia as a therapeutic intervention in acute pancreatitis.
OBJECTIVE: Recent preclinical and clinical data suggest that thoracic epidural analgesia, a technique primarily aimed at decreasing pain, might exert anti-inflammatory effects, enhance splanchnic and pancreatic blood flow during acute pancreatitis; however, the influence of epidural analgesia on mortality remains under investigated in this setting. This study was therefore designed to assess the impact of epidural analgesia on mortality in ICU patients with acute pancreatitis. DESIGN: Multicenter retrospective, observational, cohort study. SETTING: Seventeen French and Belgian ICUs. PATIENTS: All patients admitted to with acute pancreatitis between June 2009 and March 2014. INTERVENTIONS: The primary exposure was thoracic epidural analgesia versus standard care without epidural analgesia. The primary outcome was 30-day mortality. Propensity analyses were used to control for bias in treatment assignment and prognostic imbalances. MEASUREMENTS AND MAIN RESULTS: One thousand three ICU patients with acute pancreatitis were enrolled, of whom 212 died within 30 days. Epidural analgesia was used in 46 patients and was associated with reduced mortality in unadjusted analyses (4% vs. 22%; p = 0.003). After adjustment for baseline variables associated with mortality, epidural analgesia was still an independent predictor of 30-day mortality (adjusted odds ratio, 0.10; [95% CI, 0.02-0.49]; p = 0.004). Using propensity score analysis, the risk of all-cause 30-day mortality in patients with acute pancreatitis receiving epidural analgesia was significantly lower than that in matched patients who did not receive epidural analgesia (2% vs. 17%; p = 0.01). CONCLUSIONS: Among critically ill patients with acute pancreatitis, mortality at 30 days was lower in patients who received epidural analgesia than in comparable patients who did not. These findings support ongoing research on the use of epidural analgesia as a therapeutic intervention in acute pancreatitis.
Authors: Navamayooran Thavanesan; Sophie White; Shiela Lee; Bathiya Ratnayake; Kofi W Oppong; Manu K Nayar; Linda Sharp; Asbjørn Mohr Drewes; Gabriele Capurso; Enrique De-Madaria; Ajith K Siriwardena; John A Windsor; Sanjay Pandanaboyana Journal: World J Surg Date: 2022-01-07 Impact factor: 3.282