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Lookup NU author(s): Professor Sanjay PandanaboyanaORCiD, Michael Jones, Dr Manu Nayar
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).
© 2024 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.Background: The effect of analgesic modalities on short-term outcomes in acute pancreatitis remains unknown. However, preclinical models have raised safety concerns regarding opioid use in patients with acute pancreatitis. Objective: This study aimed to assess the association between analgesics, particularly opioids, and severity and mortality in hospitalised patients with acute pancreatitis. Methods: This prospective multicentre cohort study recruited consecutive patients admitted with a first episode of acute pancreatitis between April 1 and 30 June 2022, with a 1-month follow-up. Data on aetiology, clinical course, and analgesic treatment were collected. The primary outcome was the association between opioid analgesia and acute pancreatitis severity, which was analysed using univariate and multivariate analyses. Results: Among a total of 1768 patients, included from 118 centres across 27 countries, 1036 (59%) had opioids administered on admission day, and 167 (9%) received opioids after admission day. On univariate analysis, moderately severe or severe acute pancreatitis was associated with male sex, Asian ethnicity, alcohol aetiology, comorbidity, predicted severe acute pancreatitis, higher pain scores, longer pain duration and opioid treatment (all p < 0.001). On multivariate analysis, comorbidity, alcohol aetiology, longer pain duration and higher pain scores increased the risk of moderately severe or severe acute pancreatitis (all p < 0.001). Furthermore, opioids administered after admission day (but not on admission day) doubled the risk of moderately severe or severe disease (OR 2.07 (95% CI, 1.29–3.33); p = 0.003). Opioid treatment for 6 days or more was an independent risk factor for moderately severe or severe acute pancreatitis (OR 3.21 (95% CI, 2.16–4.79; p < 0.001). On univariate analysis, longer opioid duration was associated with mortality. Conclusion: Opioid treatment increased the risk of more severe acute pancreatitis only when administered after admission day or for 6 days or more. Future randomised studies should re-evaluate whether opioids might be safe in acute pancreatitis.
Author(s): Pandanaboyana S, Knoph CS, Olesen SS, Jones M, Lucocq J, Samanta J, Talukdar R, Capurso G, de-Madaria E, Yadav D, Siriwardena AK, Windsor J, Drewes AM, Nayar M, on behalf of the PAINAP Collaborative
Publication type: Article
Publication status: Published
Journal: United European Gastroenterology Journal
Year: 2024
Pages: epub ahead of print
Online publication date: 04/03/2024
Acceptance date: 05/12/2023
Date deposited: 18/03/2024
ISSN (print): 2050-6406
ISSN (electronic): 2050-6414
Publisher: John Wiley and Sons Inc
URL: https://doi.org/10.1002/ueg2.12542
DOI: 10.1002/ueg2.12542
PubMed id: 38439202
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