Procaine Hydrochloride Fails to Relieve Pain in Patients with Acute Pancreatitis

Abstract

Background: Several analgesics are in use for pain control in patients with acute pancreatitis. Procaine hydrochloride (procaine) has a long tradition and is recommended by the German Society of Gastroenterology and Metabolic Diseases for pain treatment in patients with acute pancreatitis. There is no controlled trial showing that procaine could be effective for pain treatment. Methods: In an open, randomized, controlled trial, 107 patients (76 male, 31 female; mean age 45 ± 12 years) were included and randomized either to receive procaine (n = 55) or pentazocine (n = 52) for pain relief. Procaine 2 g/ 24 h was administered by continuous intravenous infusion, pentazocine 30 mg was administered every 6 h as a bolus intravenous injection. Pentazocine was additionally administered on demand whenever required in patients of both treatment groups and its total consumption was recorded. Pain scores were assessed twice daily on a visual analogue scale. Results: Patients receiving procaine were significantly more likely to request additional analgesics compared to patients treated with pentazocine alone, 98 vs. 44%, respectively (p < 0.001). Procaine did not reduce the amount of pentazocine required for pain control. The amount of pentazocine given in both groups was not statistically significantly different. Recorded pain scores were significantly lower (p < 0.001) in patients in the pentazocine group during the first 3 days of analgesic treatment. From day 4 on there was no significant difference in pain scores among the two groups. Conclusion: Thus, intravenous procaine treatment is not effective for pain control in patients with acute pancreatitis.

Acute Pancreatitis: Treatment Strategies

“…Nowadays there are two randomized clinical trials showing that intravenously administered procaine hydrochloride is ineffective in pain treatment: the first one was able to show that procaine is less effective compared to buprenorphine [28]. Our own data prove that procaine hydrochloride is ineffective compared to pentazocine [34].…”

Efficacy and Tolerance of Metamizole versus Morphine for Acute Pancreatitis Pain

“…At present, another six controlled studies of analgesia have been published on acute pancreatitis [24][25][26][27][28][29] , one of which used pancreatic enzymes vs. placebo (with negative results) [26] . The majority of these studies used different opioids (buprenorphine [24,27] , pethidine [24] , fentanyl [28] or pentazocine [27] ) and indomethacin [25] .…”

“…Because of the high variability in the design of the studies (none of them select the same drug) it is difficult to draw a conclusion. However, in all cases, the analgesic effect of opioid is greater than that of the control [27,29] . Our data contrasts with these results.…”

Pharmacological Prevention and Treatment of Acute Pancreatitis: Where Are We Now?

“…In the fi rst, buprenorphine and opioid derivatives were more effective than procaine for pain relief but the study did not address the question whether procaine had any effect on pancreatitis at all [64] . More recently, it was shown that procaine, in a recommended dose of 2 g over 24 h given intravenously, was completely ineffectual ( table 3 ) [65] . Patients should therefore receive appropriate pain medication, including opiates according to WHO standards, and the use of systemically given local anesthetics should be discontinued -particularly in the German-speaking world [66] .…”