The safety and efficacy of epidural anaesthesia in acute pancreatitis: a systematic review and meta-analysis

Dhya Al-Leswas; Nesta Baxter; Wei B. Lim; Francis Robertson; Bathiya Ratnayake; Jayanta Samanta; Gabriele Capurso; Enrique de-Madaria; Asbjørn M. Drewes; John Windsor; Sanjay Pandanaboyana

doi:10.1016/j.hpb.2022.12.004

The safety and efficacy of epidural anaesthesia in acute pancreatitis: a systematic review and meta-analysis

Dhya Al-Leswas, Nesta Baxter, Wei B. Lim, Francis Robertson, Bathiya Ratnayake, Jayanta Samanta, Gabriele Capurso, Enrique de-Madaria, Asbjørn M. Drewes, John Windsor, Sanjay Pandanaboyana^*

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

2 Citations (Scopus)

Abstract

BACKGROUND: Acute pancreatitis (AP) has variable clinical courses. This systematic review and meta-analysis aimed to determine the safety, efficacy, and impact of epidural anaesthesia (EA) use in AP.

METHODS: The PubMed, EMBASE, SCOPUS and Cochrane library databases were systematically searched between 1980 and 2022 using the PRISMA guidelines, to identify observational and comparative studies reporting on EA in AP. The meta-analysis was performed in R Foundation for Statistical Computing using the meta R Package for Meta-Analysis.

RESULTS: A total of 9 studies with 2006 patients of which 726 (36%) patients had EA were included. All studies demonstrated high safety and feasibility of EA in AP with no reported major local or neurological complications. One randomised controlled trial demonstrated an improvement in pain severity using a 0-10 visual analogue scale (VAS) at the outset (1.6 in EA vs 3.5 in non-EA, P = 0.02) and on day 10 (0.2 in EA vs 2.33 in non-EA, P = 0.034). There was also improvement in pancreatic perfusion with EA measured with computerised tomography 13 (43%) in EA vs 2 (7%) in non-EA, P = 0.003. The need for ventilatory support and overall mortality was lower in EA patients 40 (19%) vs 285 (24%) P = 0.025 (OR: 0.49, 95% CI: 0.28-0.84) and 16 (7%) vs 214 (20%), P = 0.050 (OR: 0.39, 95% CI: 0.15-1.00), respectively.

CONCLUSION: EA is infrequently used for pain management in AP and yet the available evidence suggests that it is safe and effective in reducing pain severity, improving pancreatic perfusion, and decreasing mortality.

Original language	English
Journal	H P B
Volume	25
Issue number	2
Pages (from-to)	162-171
Number of pages	10
ISSN	1365-182X
DOIs	https://doi.org/10.1016/j.hpb.2022.12.004
Publication status	Published - Feb 2023

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@article{d443f986325648c6b549f0f538fb2ce3,

title = "The safety and efficacy of epidural anaesthesia in acute pancreatitis: a systematic review and meta-analysis",

abstract = "BACKGROUND: Acute pancreatitis (AP) has variable clinical courses. This systematic review and meta-analysis aimed to determine the safety, efficacy, and impact of epidural anaesthesia (EA) use in AP.METHODS: The PubMed, EMBASE, SCOPUS and Cochrane library databases were systematically searched between 1980 and 2022 using the PRISMA guidelines, to identify observational and comparative studies reporting on EA in AP. The meta-analysis was performed in R Foundation for Statistical Computing using the meta R Package for Meta-Analysis.RESULTS: A total of 9 studies with 2006 patients of which 726 (36%) patients had EA were included. All studies demonstrated high safety and feasibility of EA in AP with no reported major local or neurological complications. One randomised controlled trial demonstrated an improvement in pain severity using a 0-10 visual analogue scale (VAS) at the outset (1.6 in EA vs 3.5 in non-EA, P = 0.02) and on day 10 (0.2 in EA vs 2.33 in non-EA, P = 0.034). There was also improvement in pancreatic perfusion with EA measured with computerised tomography 13 (43%) in EA vs 2 (7%) in non-EA, P = 0.003. The need for ventilatory support and overall mortality was lower in EA patients 40 (19%) vs 285 (24%) P = 0.025 (OR: 0.49, 95% CI: 0.28-0.84) and 16 (7%) vs 214 (20%), P = 0.050 (OR: 0.39, 95% CI: 0.15-1.00), respectively.CONCLUSION: EA is infrequently used for pain management in AP and yet the available evidence suggests that it is safe and effective in reducing pain severity, improving pancreatic perfusion, and decreasing mortality.",

author = "Dhya Al-Leswas and Nesta Baxter and Lim, {Wei B.} and Francis Robertson and Bathiya Ratnayake and Jayanta Samanta and Gabriele Capurso and Enrique de-Madaria and Drewes, {Asbj{\o}rn M.} and John Windsor and Sanjay Pandanaboyana",

year = "2023",

month = feb,

doi = "10.1016/j.hpb.2022.12.004",

language = "English",

volume = "25",

pages = "162--171",

journal = "H P B",

issn = "1365-182X",

publisher = "Pergamon Press",

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T1 - The safety and efficacy of epidural anaesthesia in acute pancreatitis: a systematic review and meta-analysis

AU - Al-Leswas, Dhya

AU - Baxter, Nesta

AU - Lim, Wei B.

AU - Robertson, Francis

AU - Ratnayake, Bathiya

AU - Samanta, Jayanta

AU - Capurso, Gabriele

AU - de-Madaria, Enrique

AU - Drewes, Asbjørn M.

AU - Windsor, John

AU - Pandanaboyana, Sanjay

PY - 2023/2

Y1 - 2023/2

N2 - BACKGROUND: Acute pancreatitis (AP) has variable clinical courses. This systematic review and meta-analysis aimed to determine the safety, efficacy, and impact of epidural anaesthesia (EA) use in AP.METHODS: The PubMed, EMBASE, SCOPUS and Cochrane library databases were systematically searched between 1980 and 2022 using the PRISMA guidelines, to identify observational and comparative studies reporting on EA in AP. The meta-analysis was performed in R Foundation for Statistical Computing using the meta R Package for Meta-Analysis.RESULTS: A total of 9 studies with 2006 patients of which 726 (36%) patients had EA were included. All studies demonstrated high safety and feasibility of EA in AP with no reported major local or neurological complications. One randomised controlled trial demonstrated an improvement in pain severity using a 0-10 visual analogue scale (VAS) at the outset (1.6 in EA vs 3.5 in non-EA, P = 0.02) and on day 10 (0.2 in EA vs 2.33 in non-EA, P = 0.034). There was also improvement in pancreatic perfusion with EA measured with computerised tomography 13 (43%) in EA vs 2 (7%) in non-EA, P = 0.003. The need for ventilatory support and overall mortality was lower in EA patients 40 (19%) vs 285 (24%) P = 0.025 (OR: 0.49, 95% CI: 0.28-0.84) and 16 (7%) vs 214 (20%), P = 0.050 (OR: 0.39, 95% CI: 0.15-1.00), respectively.CONCLUSION: EA is infrequently used for pain management in AP and yet the available evidence suggests that it is safe and effective in reducing pain severity, improving pancreatic perfusion, and decreasing mortality.

AB - BACKGROUND: Acute pancreatitis (AP) has variable clinical courses. This systematic review and meta-analysis aimed to determine the safety, efficacy, and impact of epidural anaesthesia (EA) use in AP.METHODS: The PubMed, EMBASE, SCOPUS and Cochrane library databases were systematically searched between 1980 and 2022 using the PRISMA guidelines, to identify observational and comparative studies reporting on EA in AP. The meta-analysis was performed in R Foundation for Statistical Computing using the meta R Package for Meta-Analysis.RESULTS: A total of 9 studies with 2006 patients of which 726 (36%) patients had EA were included. All studies demonstrated high safety and feasibility of EA in AP with no reported major local or neurological complications. One randomised controlled trial demonstrated an improvement in pain severity using a 0-10 visual analogue scale (VAS) at the outset (1.6 in EA vs 3.5 in non-EA, P = 0.02) and on day 10 (0.2 in EA vs 2.33 in non-EA, P = 0.034). There was also improvement in pancreatic perfusion with EA measured with computerised tomography 13 (43%) in EA vs 2 (7%) in non-EA, P = 0.003. The need for ventilatory support and overall mortality was lower in EA patients 40 (19%) vs 285 (24%) P = 0.025 (OR: 0.49, 95% CI: 0.28-0.84) and 16 (7%) vs 214 (20%), P = 0.050 (OR: 0.39, 95% CI: 0.15-1.00), respectively.CONCLUSION: EA is infrequently used for pain management in AP and yet the available evidence suggests that it is safe and effective in reducing pain severity, improving pancreatic perfusion, and decreasing mortality.

UR - http://www.scopus.com/inward/record.url?scp=85146007930&partnerID=8YFLogxK

U2 - 10.1016/j.hpb.2022.12.004

DO - 10.1016/j.hpb.2022.12.004

M3 - Review article

C2 - 36593161

SN - 1365-182X

VL - 25

SP - 162

EP - 171

JO - H P B

JF - H P B

IS - 2

ER -

The safety and efficacy of epidural anaesthesia in acute pancreatitis: a systematic review and meta-analysis

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