An Optimal Randomized Study for Pain Control in Acute Pancreatitis

Abstract

Pain in acute pancreatitis may be a sudden onset with excruciatingly severe pain or a more gradual onset with moderate abdominal pain several hours after a large meal. The intensity of pain is not directly related to disease severity or the prognosis of acute pancreatitis. Pain control in nonsevere acute pancreatitis does not differ significantly from pain control in other acute abdominal conditions. It remains to be defined whether severe acute pancreatitis is sufficiently different from other conditions causing acute abdominal pain to warrant a specific protocol for pain control. There is limited evidence for, or against, the use of opiates in pain control, but the fear of inducing spasm of sphincter of Oddi with morphine treatment is probably without clinical importance. Opiate-based patient-controlled analgesia (PCA) is now a widely accepted practice in most parts of the world, whereas epidural analgesia is commonly used when patients are treated in an intensive care unit (ICU). Continuous systemic infusion of procaine hydrochloride (Procaine or Novocain), as recommended earlier by the German Society of Gastroenterology and Metabolic Diseases, is now obsolete, and intraduodenal enzyme supplementation must be regarded as an ineffective treatment of pain. Continuous celiac plexus block and thoracoscopic splanchnicectomy have been found to be useful in special cases, but they are technically more demanding in severely ill patients. To prevent pain and recurrence during refeeding after pancreatitis, somatostatine analogs may have a therapeutic or prophylactic role.