Impact of early thoracic epidural analgesia in patients with severe acute pancreatitis.

Abstract

This study was designed to assess the impact of thoracic epidural analgesia (TEA) in patients with severe acute pancreatitis (SAP). This is a single-centre retrospective study. In this study, the outcomes of SAP patients were compared between patients received TEA (TEA group) and without TEA (NTEA group). Early TEA was defined as TEA performed within 48hours after onset. The main outcome was the mortality at 30days after ICU admission, and secondary outcomes included the incidence of acute respiratory distress syndrome (ARDS), the acute renal injury (AKI) and sepsis, the hospital stay and hospitalization expenses. The mortality of SAP patients in TEA versus NTEA was 8.0% and 13.3% (p=.1520). Multivariate regression analysis showed significant difference in mortality between the TEA and NTEA groups (OR, 0.387; 95% CI, 0.168-0.892; p=.026). The incidence of ARDS in TEA versus NTEA was 46.0% and 62.4% (p=.0044); the proportion of patients requiring invasive ventilator assisted ventilation in TEA, and NTEA was 22.6% and 39.2% (p=.0016). The incidence of AKI in TEA versus NTEA was 27.7% and 45.3% (p=.0044); the proportion of patients needing for continuous renal replacement therapy (CRRT) in TEA and NTEA was 48.2% and 74.0% (p<.0001). The mortality of SAP patients in early TEA versus NTEA was 4.8% and 15.3% (p=.0263). TEA was associated with low incidence of ARDS and AKI in patients with SAP. Early TEA may benefit mortality in SAP patients and is a possible protective factor for the mortality of SAP patients.