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.
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References
Andrén-Sandberg Å, Zoucas E, Lillo-Gil R, Gyllstedt E, Ihse I (1996) Thoracoscopic splanchnicectomy for chronic, severe pancreatic pain. Semin Laparosc Surg 3:29-33
Bernhardt A, Kortgen A, Niesel HCh, Goertz A, 2002. Using epidural anesthesia in patients with acute pancreatitis - prospective study of 121 patients. Anaesthesiol Reanim 27, 16-22 [Article in German]
Blamey SL, Finlay IG, Carter DC, Imrie CW (1984) Analgesia in acute pancreatitis: comparison of buprenorphine and pethidine. Br Med J (Clin Res Ed) 288:1494-1495
Freise H, Lauer S, Anthonsen S, Hlouschek V, Minin E, Fischer LG, Lerch MM, Van Aken HK, Sielenkämper AW (2006) Thoracic epidural analgesia augments ileal mucosal capillary perfusion and improves survival in severe acute pancreatitis in rats. Anesthesiology 105:354-359
Ihse I, Zoucas E, Gyllstedt E, Lillo-Gil R, Andrén-Sandberg Å (1999) Bilateral thoracoscopic splanchnicectomy: effects on pancreatic pain and function. Ann Surg 230:785-790
Jakobs R, Adamek MU, von Bubnoff AC, Riemann JF (2000) Buprenorphine or procaine for pain relief in acute pancreatitis. A prospective randomized study. Scand J Gastroenterol 35:1319-1323
Kahl S, Zimmermann S, Pross M, Schulz HU, Schmidt U, Malfertheiner P (2004) Procaine hydrochloride fails to relieve pain in patients with acute pancreatitis. Digestion 69:5-9
Keller J, Andresen V, Rosien U, Layer P (2007) The patient with slightly elevated pancreatic enzymes and abdominal complaints. Best Pract Res Clin Gastroenterol. 21:519-533
Kune GA, Cole R, Bell S (1975) Observations on the relief of pancreatic pain. Med J Aust 2:789-790
Thompson DR (2001) Narcotic analgesic effects on the sphincter of Oddi: a review of the data and therapeutic implications in treating pancreatitis. Am J Gastroenterol 96:1266-1272
Lévy P, Heresbach D, Pariente EA, Boruchowicz A, Delcenserie R, Millat B, Moreau J, Le Bodic L, de Calan L, Barthet M, Sauvanet A, Bernades P (1997) Frequency and risk factors of recurrent pain during refeeding in patients with acute pancreatitis: a multivariate multicentre prospective study of 116 patients. Gut 40:262-266
Lévy P, Hastier P, Arotçarena R, Bartolie E, Bougeard-Julien M, Blumberg J, O’Toole D, Ruszniewski P (2004) Efficacy of lanreotide 30 mg on prevention of pain relapse after oral refeeding in patients with necrotizing acute pancreatitis. A phase II prospective multicentre study. Pancreatology 4:229-232
Mössner J (1993) Is there a place for pancreatic enzymes in the treatment of pain in chronic pancreatitis? Digestion 54(Suppl 2):35-39
Mössner J, Secknus R, Meyer J, Niederau C, Adler G (1992) Treatment of pain with pancreatic extracts in chronic pancreatitis: results of a prospective placebo-controlled multicenter trial. Digestion 53:54-66
Patankar RV, Chand R, Johnson CD (1995) Pancreatic Enzyme Supplementation in Acute Pancreatitis. HPB Surg 8:159-162
Rykowski JJ, Hilgier M (1995) Continuous celiac plexus block in acute pancreatitis. Reg Anesth 20:528-532
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Andrén-Sandberg, Å., Mayerle, J.V., Siriwardena, A.K., Berry, D.P., Kirk, G.R., Lerch, M.M. (2010). An Optimal Randomized Study for Pain Control in Acute Pancreatitis. In: Johnson, C., Imrie, C. (eds) Pancreatic Disease. Springer, London. https://doi.org/10.1007/978-1-84882-118-7_5
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DOI: https://doi.org/10.1007/978-1-84882-118-7_5
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