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Analgesia in paediatric acute pancreatitis: A scoping systematic review
James Lucocq1, Nejo Joseph2, Cecilie Sigaard Knoph3
1Department of General Surgery, NHS Lothian, Edinburgh, UK.
Insights
Opioids are common for treating pain in children with acute pancreatitis (AP). However, optimal pain management strategies and their long-term effects remain unknown, highlighting a need for further research in pediatric pain relief.
Area of Science:
- Pediatric Gastroenterology
- Pain Management
- Evidence-Based Medicine
Background:
- Acute pancreatitis (AP) is a frequent pediatric condition.
- Optimal analgesic practices for pediatric AP lack robust supporting data.
- Current understanding of analgesic trends and outcomes in pediatric AP is limited.
Purpose of the Study:
- To conduct a scoping review of analgesic practices in pediatric acute pancreatitis.
- To investigate trends in analgesic strategies used for pediatric AP.
- To evaluate the impact of different analgesic modalities on patient outcomes.
Main Methods:
- Systematic literature search across major databases (Medline, Embase, CENTRAL, Pubmed Central, Google Scholar).
- Two independent investigators conducted the search.
- Adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.
Main Results:
- Three retrospective North American cohort studies involving 658 pediatric patients were reviewed.
- Opioids were the most common analgesics (59.5%), with decreasing administration rates noted since 2014/2017.
- Limited data existed on acetaminophen and NSAIDs; no studies reported on complications, quality of life, or long-term post-discharge use.
Conclusions:
- Opioids are the primary analgesic choice for pediatric AP in North America.
- Significant knowledge gaps exist regarding factors influencing analgesic choice, outcomes, and long-term use.
- Further research is essential to establish evidence-based guidelines for managing pain in pediatric AP.
Objective:
Acute pancreatitis (AP) is a common paediatric condition, yet there is little data to support optimal analgesic practice. The aim of this scoping review was to report analgesic practice, investigate trends in analgesic strategy and evaluate the impact of analgesic modality on outcomes.
Methods:
A systematic search of Medline, Embase, CENTRAL, Pubmed Central and Google Scholar was performed by two independent investigators. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.
Results:
Three retrospective cohort studies, all conducted in North America, reported on analgesic practice in paediatric AP. The studies included 658 patients (median age, 12 years; female sex, 57%; non-biliary aetiology, 85.9%). Overall, analgesia was administered in 67% of patients, including opioids in 59.5% (43.8%-71.4%). Rates of acetaminophen (17.9% and 77.7%) and non-steroidal anti-inflammatory drugs (7.7% and 40.2%) were reported in two studies. Two studies reported reducing rates of opioid administration or reduced duration of opioid administration since 2017 and 2014, respectively. One study did not find any correlation between opioid administration and sociodemographic factors, length of stay or admission to intensive care units. No studies reported on complications or quality of life. No studies investigated non-medical modalities. There were no long-term data on analgesic use post-discharge.
Conclusions:
Opioids are the mainstay of pain treatment in paediatric AP in North America. However, factors that influence the analgesic type, the impact of analgesic modality on the post-pancreatitis outcome and long-term analgesic use constitute a knowledge gap. Future studies are needed to inform analgesic use in paediatric AP.
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