The Effect of Epidural Analgesia on In-Hospital Outcomes in Patients with Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Abstract

Acute pancreatitis (AP) can lead to severe complications and high mortality. Previous studies suggest that epidural analgesia (EA) may reduce AP severity and improve outcomes. This systematic review and meta-analysis aimed to evaluate the efficacy of EA on in-hospital outcomes in AP patients. Electronic databases (PubMed, Medline-Ovid, Scopus, CINAHL, Web of Science) were systematically searched until mid-May 2024 for RCTs comparing EA with other pain management strategies in AP patients. Variables were pooled using weighted mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (CIs). Data analysis employed a random-effects model and the Mantel-Haenszel method. Study heterogeneity was assessed using the I2 statistic. Five RCTs with 260 participants were included. Meta-analysis showed no significant differences in in-hospital mortality (RR = 0.69, 95% CI [0.29, 1.65], p = 0.40), mechanical ventilation (RR = 0.82, 95% CI [0.61, 1.10], p = 0.19), sepsis events (RR = 0.88, 95% CI [0.42, 1.86], p = 0.74), hospital/ICU stay (WMD = 0.49 days, 95% CI [-1.13, 2.10], p = 0.55), and pain score (WMD = 1.49, 95% CI [-0.42, 3.40], p = 0.13). However, opioid requirements were significantly lower, as reported by one study with morphine milligram equivalent of 15 mg/day compared to 52 mg/day in the control group (p = 0.001). Heterogeneity was low to moderate for most outcomes but high for pain score (I2 = 92%). The overall certainty of evidence was very low due to the small number of studies, risk of bias, and limited sample size. EA did not significantly improve in-hospital outcomes in AP patients. However, findings indicated reduced opioid consumption in the EA group, suggesting potential benefits in pain management. Further high-quality, large-scale randomized trials are needed to understand the potential benefits of EA in this population.