The Use of Fractional Epidural Block in the Management of Acute Pancreatitis

Je, Berk; Lw, Krumperman

doi:10.1097/00000441-195211000-00004

Cited by 13 publications

(11 citation statements)

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“…In theory, amylase elevations in ICU patients with COVID-19 reflect pancreatic inflammation (ie, amylase production) rather than changes in small bowel permeability, and elevated amylase has not consistently been associated with worsened outcomes in retrospective analyses of general (non-critically ill) hospitalized populations. [4][5][6] Nonetheless, results from this study implicate bowel and perhaps pancreatic dysfunction in the propagation of severe disease in patients with COVID-19. Our design does not allow definitive mechanistic conclusions, and we welcome further data to corroborate or refute our findings.…”

Section: Discussionmentioning

confidence: 81%

“…Regarding safety outcomes, 5 studies reported incidences of epidural-related hypotension, which ranged from 0% to 37.5%. All episodes of epidural-related hypotension were successfully managed by intravenous fluids or vasopressors 3–5,7,8 . No incidences of postprocedural epidural hematoma or abscess were reported.…”

Section: Resultsmentioning

confidence: 99%

“…Regarding clinical outcomes of AP, 4 studies reported the median hospital stay to range from 8 to 26 days 3,4,7,9 . Mortality was reported in 7 studies, with in-hospital mortality ranging from 0% to 25.0% 3–5,7–10 . A 2018 cohort study reported that TEA was independently associated with reduced mortality by more than 5-fold (4% in the TEA group vs 22% in the control group) 10 ; however, this significant improvement in mortality was not repeatable in 2 other clinical trials 3,4 …”

Section: Resultsmentioning

confidence: 99%

“…The risk of bias was mainly from the risk of confounding. [5][6][7][8][9] The overall evidence level was low.…”

Section: Age In Mean (Sd) ‡mentioning

confidence: 99%

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Thoracic Epidural Analgesia in Acute Pancreatitis

Hui

Leung

2022

Pancreas

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A bdominal pain is a cardinal feature of acute pancreatitis (AP), and thoracic epidural analgesia (TEA) has been studied as an advanced analgesic strategy in AP. 1 Aside from analgesia, TEA has secondary effects of sympathetic blockade, which may lead to splanchnic vasodilation and improvement of pancreatic microcirculation. 2 Thoracic epidural analgesia has hence been evaluated as a disease-modifying therapy for AP in clinical studies. 3,4 We performed a systematic review to assess the safety of TEA and its impact on clinical outcomes in AP. MATERIALS AND METHODSThis systematic review was performed in accordance to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was registered in PROSPERO (CRD42021281548). A literature search was performed on MEDLINE, Embase, and the Cochrane Li-brary from inception until September 15, 2021, with the MeSH terms and synonyms of (1) "epidural analgesia" and (2) "acute pancreatitis." Original studies on TEA in AP patients were included, with no limit on publication date. The articles were independently screened by 2 reviewers for inclusion and data extraction.Risk of bias and level of evidence were assessed with the Cochrane Risk of Bias tool and the Grades of Recommendation, Assessment, Development, and Evaluation system, respectively.

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Section: Discussionmentioning

confidence: 81%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…The risk of bias was mainly from the risk of confounding. [5][6][7][8][9] The overall evidence level was low.…”

Section: Age In Mean (Sd) ‡mentioning

confidence: 99%

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Thoracic Epidural Analgesia in Acute Pancreatitis

Hui

Leung

2022

Pancreas

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“…The use of fractional epidural block goes back to the early 1950s [69] . This has been revived recently [70][71][72][73] and was found to be a feasible procedure for unsedated patients without coagulation disorders.…”

Section: Pain Controlmentioning

confidence: 99%

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

Lankisch

Lerch²

2006

Dig Dis

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Acute pancreatitis is a disease of increasing prevalence, unchanged mortality over many decades, and limited treatment strategies. Progress has been made in developing therapies that reduce the rate of endoscopic retrograde cholangiopancreatography (ERCP)-associated pancreatitis and in preventing infected pancreatic necrosis with intravenous carbapenems. Attempts at reducing pancreatic enzyme output or inhibiting the activity of digestive enzyme proteases have not yielded encouraging results – nor have anti-inflammatory strategies for the treatment of acute pancreatitis been found to be effective so far. Future therapeutic options that are presently being developed or under investigation attempt to restore pancreatic secretory function, interfere with inflammatory pathways in a more effective manner, or inhibit digestive enzyme proteases more selectively.

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Pancreatic ischaemia in experimental acute pancreatitis: Mechanism, significance and therapy

Klar

Meßmer

Warshaw

et al. 1990

Journal of British Surgery

246

123

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Much clinical and experimental evidence suggests that pancreatic ischaemia in the early phase of acute pancreatitis is important in the development of pancreatic necrosis. While depletion of intravascular volume has often been assumed to be the main circulatory defect, an additional disturbance of pancreatic microcirculation has been demonstrated experimentally. Possible contributory mechanisms include chemical-induced vasoconstriction, direct injury of vessel wall, intravascular coagulation and increased endothelial permeability resulting in pancreatic oedema, haemoconcentration and impaired venous drainage. Pancreatic ischaemia as a consequence of these local effects seems to be responsible for the transition of mild pancreatitis to parenchymal necrosis. In experimental models the beneficial effect of various drugs and of sympathetic blockade has been ascribed to an improvement in pancreatic perfusion. Although effective volume therapy is generally accepted as the mainstay of conservative treatment in acute pancreatitis, the efficacy of different fluid preparations is still controversial, and simple fluid resuscitation has not been shown to prevent the development of parenchymal necrosis. The specific impairment of pancreatic microcirculation cannot be prevented merely by replenishment of intravascular volume with crystalloids, albumin or plasma despite normalization of macrohaemodynamics. In contrast, partial replacement of blood by dextran preparations has been shown to increase pancreatic perfusion by improving blood fluidity. Isovolaemic haemodilution in conjunction with conventional fluid therapy may provide a new and effective means of protecting the pancreas from secondary injury due to the early ischaemic phase of acute pancreatitis.

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The Use of Fractional Epidural Block in the Management of Acute Pancreatitis

Cited by 13 publications

References 0 publications

Thoracic Epidural Analgesia in Acute Pancreatitis

Thoracic Epidural Analgesia in Acute Pancreatitis

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

Pancreatic ischaemia in experimental acute pancreatitis: Mechanism, significance and therapy

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