The Effect of Epidural Analgesia on In-Hospital Outcomes in Patients with Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

IF 1.7 4区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pancreas Pub Date : 2024-12-02 DOI:10.1097/MPA.0000000000002444

Bobak Moazzami, Zinat Mohammadpour, Zohyra E Zabala, Saurabh Chawla

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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 reduce AP severity and improve outcomes. This systematic review and meta-analysis aimed to evaluate the efficacy of EA on in-hospital outcomes in AP patients.

Method: Electronic databases (PubMed, Medline-Ovid, Scopus, CINAHL, Web of Science) were systematically searched until mid-May 2024 for RCTs comparing EA with other pain management strategies in AP patients. Variables were pooled using weighted mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (CIs). Data analysis employed a random-effects model and the Mantel-Haenszel method. Study heterogeneity was assessed using the I2 statistic.

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 events (RR = 0.88, 95% CI [0.42, 1.86], p = 0.74), hospital/ICU stay (WMD = 0.49 days, 95% CI [-1.13, 2.10], p = 0.55), and pain score (WMD = 1.49, 95% CI [-0.42, 3.40], p = 0.13). However, opioid requirements were significantly lower, as reported by one study with morphine milligram equivalent of 15 mg/day compared to 52 mg/day in the control group (p = 0.001). Heterogeneity was low to moderate for most outcomes but high for pain score (I2 = 92%). The overall certainty of evidence was very low due to the small number of studies, risk of bias, and limited sample size.

Conclusions: EA did not significantly improve in-hospital outcomes in AP patients. However, findings indicated reduced opioid consumption in the EA group, suggesting potential benefits in pain management. Further high-quality, large-scale randomized trials are needed to understand the potential benefits of EA in this population.

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硬膜外镇痛对急性胰腺炎患者住院结局的影响：随机临床试验的系统回顾和荟萃分析

目的：急性胰腺炎（AP）可导致严重的并发症和高死亡率。以往的研究表明，硬膜外镇痛（EA）可以减轻AP的严重程度并改善预后。本系统综述和荟萃分析旨在评估EA对AP患者住院预后的影响。方法：系统检索电子数据库（PubMed, Medline-Ovid, Scopus， CINAHL, Web of Science），直到2024年5月中旬，比较EA与其他AP患者疼痛管理策略的随机对照试验。采用加权平均差（WMD）或95%置信区间（ci）的风险比（RR）合并变量。数据分析采用随机效应模型和Mantel-Haenszel方法。采用I2统计量评估研究异质性。结果：纳入5项随机对照试验，共260名受试者。meta分析显示，院内死亡率（RR = 0.69, 95% CI [0.29, 1.65], p = 0.40）、机械通气（RR = 0.82, 95% CI [0.61, 1.10], p = 0.19）、脓毒症事件（RR = 0.88, 95% CI [0.42, 1.86], p = 0.74）、住院/ICU住院时间（WMD = 0.49天，95% CI [-1.13, 2.10], p = 0.55）和疼痛评分（WMD = 1.49, 95% CI [-0.42, 3.40], p = 0.13）无显著差异。然而，阿片类药物的需要量明显较低，一项研究报道，吗啡毫克当量为15毫克/天，而对照组为52毫克/天（p = 0.001）。大多数结果的异质性为低至中等，但疼痛评分的异质性较高（I2 = 92%）。由于研究数量少、存在偏倚风险和样本量有限，证据的总体确定性非常低。结论：EA并没有显著改善AP患者的住院预后。然而，研究结果表明，EA组的阿片类药物消耗量减少，这表明在疼痛管理方面有潜在的益处。需要进一步的高质量、大规模随机试验来了解EA在这一人群中的潜在益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pancreas 医学-胃肠肝病学

CiteScore

4.70

自引率

3.40%

发文量

289

审稿时长

1 months

期刊介绍： Pancreas provides a central forum for communication of original works involving both basic and clinical research on the exocrine and endocrine pancreas and their interrelationships and consequences in disease states. This multidisciplinary, international journal covers the whole spectrum of basic sciences, etiology, prevention, pathophysiology, diagnosis, and surgical and medical management of pancreatic diseases, including cancer.