Analgesia in the Initial Management of Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials
Navamayooran Thavanesan
Department of General Surgery, Salisbury Hospital Foundation Trust, Salisbury, UK
Search for more papers by this authorSophie White
Department of General Surgery, Royal Hampshire County Hospital, Winchester, UK
Search for more papers by this authorShiela Lee
Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK
Search for more papers by this authorBathiya Ratnayake
Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
Search for more papers by this authorKofi W. Oppong
Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK
Search for more papers by this authorManu K. Nayar
Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK
Search for more papers by this authorLinda Sharp
Population Health Sciences Institute, Newcastle University, Newcastle, UK
Search for more papers by this authorAsbjørn Mohr Drewes
Department of Gastroenterology, Center for Pancreatic Diseases, Aalborg University Hospital, Aalborg, Denmark
Search for more papers by this authorGabriele Capurso
Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
Search for more papers by this authorEnrique De-Madaria
Department of Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain
Search for more papers by this authorAjith K. Siriwardena
HPB Unit, Manchester Royal Infirmary, Manchester, UK
Search for more papers by this authorJohn A. Windsor
Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
Search for more papers by this authorCorresponding Author
Sanjay Pandanaboyana
Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK
Population Health Sciences Institute, Newcastle University, Newcastle, UK
[email protected]Search for more papers by this authorNavamayooran Thavanesan
Department of General Surgery, Salisbury Hospital Foundation Trust, Salisbury, UK
Search for more papers by this authorSophie White
Department of General Surgery, Royal Hampshire County Hospital, Winchester, UK
Search for more papers by this authorShiela Lee
Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK
Search for more papers by this authorBathiya Ratnayake
Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
Search for more papers by this authorKofi W. Oppong
Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK
Search for more papers by this authorManu K. Nayar
Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK
Search for more papers by this authorLinda Sharp
Population Health Sciences Institute, Newcastle University, Newcastle, UK
Search for more papers by this authorAsbjørn Mohr Drewes
Department of Gastroenterology, Center for Pancreatic Diseases, Aalborg University Hospital, Aalborg, Denmark
Search for more papers by this authorGabriele Capurso
Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
Search for more papers by this authorEnrique De-Madaria
Department of Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain
Search for more papers by this authorAjith K. Siriwardena
HPB Unit, Manchester Royal Infirmary, Manchester, UK
Search for more papers by this authorJohn A. Windsor
Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
Search for more papers by this authorCorresponding Author
Sanjay Pandanaboyana
Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK
Population Health Sciences Institute, Newcastle University, Newcastle, UK
[email protected]Search for more papers by this authorSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00268-021-06420-w.
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.
Supporting Information
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Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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