Navamayooran Thavanesan1, Sophie White2, Shiela Lee3, Bathiya Ratnayake4, Kofi W Oppong3, Manu K Nayar3, Linda Sharp5, Asbjørn Mohr Drewes6, Gabriele Capurso7, Enrique De-Madaria8, Ajith K Siriwardena9, John A Windsor4, Sanjay Pandanaboyana10,11. 1. Department of General Surgery, Salisbury Hospital Foundation Trust, Salisbury, UK. 2. Department of General Surgery, Royal Hampshire County Hospital, Winchester, UK. 3. Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK. 4. Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. 5. Population Health Sciences Institute, Newcastle University, Newcastle, UK. 6. Department of Gastroenterology, Center for Pancreatic Diseases, Aalborg University Hospital, Aalborg, Denmark. 7. Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy. 8. Department of Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain. 9. HPB Unit, Manchester Royal Infirmary, Manchester, UK. 10. Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK. sanjay.pandanaboyana@ncl.ac.uk. 11. Population Health Sciences Institute, Newcastle University, Newcastle, UK. sanjay.pandanaboyana@ncl.ac.uk.
Abstract
BACKGROUND: The optimal analgesic strategy for patients with acute pancreatitis (AP) remains unknown. OBJECTIVE: The present systematic review and meta-analysis aims to compare the efficacy of different analgesic modalities trialled in AP. METHODS: A systematic search of PubMed, MEDLINE, EMBASE, CENTRAL, SCOPUS and Web of Science conducted up until June 2021, identified all randomised control trials (RCTs) comparing analgesic modalities in AP. A pooled analysis was undertaken of the improvement in pain scores as reported on visual analogue scale (VAS) on day 0, day 1 and day 2. RESULTS: Twelve RCTs were identified including 542 patients. Seven trial drugs were compared: opiates, non-steroidal anti-inflammatories (NSAIDs), metamizole, local anaesthetic, epidural, paracetamol, and placebo. Across all modalities, the pooled VAS scores showed global improvement from baseline to day 2. Epidural analgesia appears to provide the greatest improvement in VAS within the first 24 h but is equivalent to opiates by 48 h. Within 24 h, NSAIDs offered similar pain-relief to opiates, while placebo also showed equivalence to other modalities but then plateaued. Local anaesthetics demonstrated least overall efficacy. VAS scores for opiate and non-opiate analgesics were comparable at baseline and day 1. The identified RCTs demonstrated significant statistical and methodological heterogeneity in pain-relief reporting. CONCLUSIONS: There is remarkable paucity of level 1 evidence to guide pain management in AP with small datasets per study. Epidural administration appears effective within the first 24 h of AP although infrequently used and featured in only a single RCT. NSAIDs are an effective opiate sparing alternative during the first 24 h.
BACKGROUND: The optimal analgesic strategy for patients with acute pancreatitis (AP) remains unknown. OBJECTIVE: The present systematic review and meta-analysis aims to compare the efficacy of different analgesic modalities trialled in AP. METHODS: A systematic search of PubMed, MEDLINE, EMBASE, CENTRAL, SCOPUS and Web of Science conducted up until June 2021, identified all randomised control trials (RCTs) comparing analgesic modalities in AP. A pooled analysis was undertaken of the improvement in pain scores as reported on visual analogue scale (VAS) on day 0, day 1 and day 2. RESULTS: Twelve RCTs were identified including 542 patients. Seven trial drugs were compared: opiates, non-steroidal anti-inflammatories (NSAIDs), metamizole, local anaesthetic, epidural, paracetamol, and placebo. Across all modalities, the pooled VAS scores showed global improvement from baseline to day 2. Epidural analgesia appears to provide the greatest improvement in VAS within the first 24 h but is equivalent to opiates by 48 h. Within 24 h, NSAIDs offered similar pain-relief to opiates, while placebo also showed equivalence to other modalities but then plateaued. Local anaesthetics demonstrated least overall efficacy. VAS scores for opiate and non-opiate analgesics were comparable at baseline and day 1. The identified RCTs demonstrated significant statistical and methodological heterogeneity in pain-relief reporting. CONCLUSIONS: There is remarkable paucity of level 1 evidence to guide pain management in AP with small datasets per study. Epidural administration appears effective within the first 24 h of AP although infrequently used and featured in only a single RCT. NSAIDs are an effective opiate sparing alternative during the first 24 h.
Authors: Samira M Sadowski; Axel Andres; Philippe Morel; Eduardo Schiffer; Jean-Louis Frossard; Alexandra Platon; Pierre-Alexandre Poletti; Leo Bühler Journal: World J Gastroenterol Date: 2015-11-21 Impact factor: 5.742