Moazzami, Bobak, Mohammadpour, Zinat, Zabala, Zohyra E., and Chawla, Saurabh (2024) The Effect of Epidural Analgesia on In-hospital Outcomes in Patients With Acute Pancreatitis: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Pancreas, 54 (4). e369-e377.

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Abstract

Objectives: Acute pancreatitis (AP) can lead to severe complications and high mortality. Previous studies suggest that epidural analgesia (EA) may improve outcomes in AP. This systematic review and meta-analysis aimed to evaluate the efficacy of EA on in-hospital outcomes in AP patients. Methods: Electronic databases (PubMed, Medline-Ovid, Scopus, CINAHL, Web of Science) were systematically searched until May 2024 for RCTs comparing EA with other pain strategies in AP patients. Variables were pooled using weighted mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (CIs). Data analysis employed random-effects the Mantel-Haenszel method and I2 statistic was used for heterogeneity. Results: Five RCTs with 260 participants were included. Meta-analysis showed no significant differences in in-hospital mortality (RR, 0.69; 95% CI [0.29-1.65]; P = 0.40), mechanical ventilation (RR, 0.82; 95% CI [0.61-1.10]; P = 0.19), sepsis (RR, 0.88; 95% CI [0.42-1.86]; P = 0.74), hospital/ICU stay (WMD, 0.49 days; 95% CI [-1.13 to 2.10]; P = 0.55), and pain score (WMD, 1.49; 95% CI [-0.42 to 3.40]; P = 0.13). Opioid requirements were significantly lower, with one study reporting MME of 15 mg/d compared to 52 mg/d in the control group (P = 0.001). Heterogeneity was low to moderate for most outcomes but high for pain score (I 2 = 92%). Small number of studies, risk of bias, and sample size limited overall certainity. Conclusions: EA did not significantly improve in-hospital outcomes in AP patients. However, findings suggested potential benefits in pain management. High-quality randomized trials are needed to understand the potential benefits of EA in this population.

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