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The safety and efficacy of epidural anaesthesia in acute pancreatitis: a systematic review and meta-analysis

Lookup NU author(s): Professor Sanjay PandanaboyanaORCiD

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Abstract

Background: Acute pancreatitis (AP) has variable clinical courses. This systematic review and meta-analysis aimed to determine the safety, efficacy, and impact of epidural anaesthesia (EA) use in AP.Methods: The PubMed, EMBASE, SCOPUS and Cochrane library databases were systematically searched between 1980 and 2022 using the PRISMA guidelines, to identify observational and comparative studies reporting on EA in AP. The meta-analysis was performed in R Foundation for Statistical Computing using the meta R Package for Meta-Analysis.Results: A total of 9 studies with 2006 patients of which 726 (36%) patients had EA were included. All studies demonstrated high safety and feasibility of EA in AP with no reported major local or neurological complications. One randomised controlled trial demonstrated an improvement in pain severity using a 0-10 visual analogue scale (VAS) at the outset (1.6 in EA vs 3.5 in non-EA, P = 0.02) and on day 10 (0.2 in EA vs 2.33 in non-EA, P = 0.034). There was also improvement in pancreatic perfusion with EA measured with computerised tomography 13 (43%) in EA vs 2 (7%) in non-EA, P = 0.003. The need for ventilatory support and overall mortality was lower in EA patients 40 (19%) vs 285 (24%) P = 0.025 (OR: 0.49, 95% CI: 0.28-0.84) and 16 (7%) vs 214 (20%), P = 0.050 (OR: 0.39, 95% CI: 0.15-1.00), respectively.Conclusion: EA is infrequently used for pain management in AP and yet the available evidence suggests that it is safe and effective in reducing pain severity, improving pancreatic perfusion, and decreasing mortality.

Publication metadata

Author(s): Al-Lewas D, Baxter N, Lim W, Robertson F, Ratnayake B, Samanta J, Capurso G, Drewes A, Windsor J, Pandanaboyana S

Publication type: Article

Publication status: Published

Journal: HPB

Year: 2023

Volume: 25

Issue: 2

Pages: 162-171

Print publication date: 01/02/2023

Online publication date: 14/12/2022

Acceptance date: 09/12/2022

ISSN (print): 1365-182X

ISSN (electronic): 1477-2574

Publisher: Elsevier Ltd

URL: https://doi.org/10.1016/j.hpb.2022.12.004

DOI: 10.1016/j.hpb.2022.12.004

PubMed id: 36593161

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