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Opioid analgesia and severity of acute pancreatitis: An international multicentre cohort study on pain management in
Sanjay Pandanaboyana1,2, Cecilie Siggaard Knoph3,4, Søren Schou Olesen3,4
1HPB and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK.
United European Gastroenterology Journal
|March 5, 2024
Summary
Opioid use in acute pancreatitis patients increases severity risk when given after admission or for extended periods. Further research is needed to confirm opioid safety in acute pancreatitis management.
Area of Science:
- Gastroenterology
- Clinical Pharmacology
- Epidemiology
Background:
- The impact of pain management on acute pancreatitis outcomes is not well understood.
- Preclinical studies suggest potential risks associated with opioid administration in acute pancreatitis.
Purpose of the Study:
- To investigate the association between analgesic use, specifically opioids, and the severity and mortality of acute pancreatitis.
- To evaluate the safety of different opioid administration strategies in hospitalized acute pancreatitis patients.
Main Methods:
- A prospective, multicenter cohort study involving 1768 patients with a first episode of acute pancreatitis.
- Data collection included aetiology, clinical course, and analgesic treatment over a 1-month follow-up period.
- Primary outcome analysis focused on the relationship between opioid analgesia and pancreatitis severity using univariate and multivariate models.
Main Results:
- Opioid administration after admission day (OR 2.07) and treatment duration of 6 days or more (OR 3.21) were independently associated with increased risk of moderately severe or severe acute pancreatitis.
- Univariate analysis indicated a link between longer opioid duration and mortality.
- Factors like male sex, Asian ethnicity, alcohol aetiology, comorbidity, and higher pain scores were also associated with severe pancreatitis.
Conclusions:
- Opioid administration after admission or for prolonged durations (≥6 days) elevates the risk of severe acute pancreatitis.
- The findings suggest a need for careful consideration of opioid timing and duration in acute pancreatitis management.
- Further randomized controlled trials are recommended to definitively assess opioid safety in this patient population.
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