Opioid analgesia and severity of acute pancreatitis: An international multicentre cohort study on pain management in acute pancreatitis

被引：19

作者：

Pandanaboyana, Sanjay ^{[1
,2
,13
]}

Knoph, Cecilie Siggaard ^{[3
,4
]}

Olesen, Soren Schou ^{[3
,4
]}

Jones, Michael ^{[1
]}

Lucocq, James ^{[5
]}

Samanta, Jayanta ^{[6
]}

Talukdar, Rupjyoti ^{[7
]}

Capurso, Gabriele ^{[8
]}

de-Madaria, Enrique ^{[9
]}

Yadav, Dhiraj ^{[10
]}

Siriwardena, Ajith K. ^{[11
]}

Windsor, John ^{[12
]}

Drewes, Asbjorn Mohr ^{[3
,4
]}

Nayar, Manu ^{[1
,2
]}

机构：

[1] Freeman Rd Hosp, HPB & Transplant Unit, Newcastle Upon Tyne, England

[2] Newcastle Univ, Populat Hlth Sci Inst, Newcastle Upon Tyne, England

[3] Aalborg Univ Hosp, Dept Gastroenterol & Hepatol, Ctr Pancreat Dis, Aalborg, Denmark

[4] Aalborg Univ, Dept Clin Med, Aalborg, Denmark

[5] Royal Infirm Edinburgh NHS Trust, Dept HPB Surg, Edinburgh, Scotland

[6] Post Grad Inst Med Educ & Res, Dept Gastroenterol, Chandigarh, India

[7] Asian Inst Gastroenterol, Hyderabad, India

[8] Univ Vita Salute San Raffaele, Pancreat Biliary Endoscopy Div, Milan, Italy

[9] Dr Balmis Gen Univ Hosp, Gastroenterol Dept, Alicante, Spain

[10] Univ Pittsburgh, Med Ctr, Div Gastroenterol & Hepatol, Pittsburgh, PA USA

[11] Manchester Royal Infirm, HBP Unit, Manchester, England

[12] Univ Auckland, Surg & Translat Res Ctr, Auckland, New Zealand

[13] Freeman Rd Hosp, Newcastle Upon Tyne, England

来源：

UNITED EUROPEAN GASTROENTEROLOGY JOURNAL | 2024年 / 12卷 / 03期

关键词：

acute pancreatitis; alcoholic; analgesia; morbidity; mortality; opioid; pain; severity; RECEPTOR ANTAGONIST; CLASSIFICATION; DEFINITIONS; PREDICTION; GUIDELINES; MORTALITY; PROTOCOL; TRIAL;

D O I：

10.1002/ueg2.12542

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

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.

引用

页码：326 / 338

页数：13