Opioid analgesia and severity of acute pancreatitis: An international multicentre cohort study on pain management in acute pancreatitis

Author:

Pandanaboyana Sanjay12ORCID,Knoph Cecilie Siggaard34ORCID,Olesen Søren Schou34ORCID,Jones Michael1,Lucocq James5,Samanta Jayanta6,Talukdar Rupjyoti7ORCID,Capurso Gabriele8ORCID,de‐Madaria Enrique9ORCID,Yadav Dhiraj10,Siriwardena Ajith K.11,Windsor John12,Drewes Asbjørn Mohr34ORCID,Nayar Manu12,

Affiliation:

1. HPB and Transplant Unit Freeman Hospital Newcastle Upon Tyne UK

2. Population Health Sciences Institute Newcastle University Newcastle Upon Tyne UK

3. Centre for Pancreatic Diseases, Department of Gastroenterology & Hepatology Aalborg University Hospital Aalborg Denmark

4. Department of Clinical Medicine Aalborg University Aalborg Denmark

5. Department of HPB Surgery Royal Infirmary of Edinburgh Edinburgh UK

6. Department of Gastroenterology Post Graduate Institute of Medical Education and Research Chandigarh India

7. Asian Institute of Gastroenterology Hyderabad India

8. Pancreatico‐Biliary Endoscopy Division Vita‐Salute San Raffaele University Milan Italy

9. Gastroenterology Department Dr. Balmis General University Hospital Alicante Spain

10. Division of Gastroenterology & Hepatology University of Pittsburgh Medical Centre Pittsburgh Pennsylvania USA

11. HBP Unit Manchester Royal Infirmary Manchester UK

12. Surgical and Translational Research Centre University of Auckland Auckland New Zealand

Abstract

AbstractBackgroundThe effect of analgesic modalities on short‐term outcomes in acute pancreatitis remains unknown. However, preclinical models have raised safety concerns regarding opioid use in patients with acute pancreatitis.ObjectiveThis study aimed to assess the association between analgesics, particularly opioids, and severity and mortality in hospitalised patients with acute pancreatitis.MethodsThis prospective multicentre cohort study recruited consecutive patients admitted with a first episode of acute pancreatitis between April 1 and 30 June 2022, with a 1‐month follow‐up. Data on aetiology, clinical course, and analgesic treatment were collected. The primary outcome was the association between opioid analgesia and acute pancreatitis severity, which was analysed using univariate and multivariate analyses.ResultsAmong a total of 1768 patients, included from 118 centres across 27 countries, 1036 (59%) had opioids administered on admission day, and 167 (9%) received opioids after admission day. On univariate analysis, moderately severe or severe acute pancreatitis was associated with male sex, Asian ethnicity, alcohol aetiology, comorbidity, predicted severe acute pancreatitis, higher pain scores, longer pain duration and opioid treatment (all p < 0.001). On multivariate analysis, comorbidity, alcohol aetiology, longer pain duration and higher pain scores increased the risk of moderately severe or severe acute pancreatitis (all p < 0.001). Furthermore, opioids administered after admission day (but not on admission day) doubled the risk of moderately severe or severe disease (OR 2.07 (95% CI, 1.29–3.33); p = 0.003). Opioid treatment for 6 days or more was an independent risk factor for moderately severe or severe acute pancreatitis (OR 3.21 (95% CI, 2.16–4.79; p < 0.001). On univariate analysis, longer opioid duration was associated with mortality.ConclusionOpioid treatment increased the risk of more severe acute pancreatitis only when administered after admission day or for 6 days or more. Future randomised studies should re‐evaluate whether opioids might be safe in acute pancreatitis.

Publisher

Wiley

Reference29 articles.

1. Global Incidence of Acute Pancreatitis Is Increasing Over Time: A Systematic Review and Meta-Analysis

2. Factors Associated With Opioid Use in Patients Hospitalized for Acute Pancreatitis

3. Morphine worsens the severity and prevents pancreatic regeneration in mouse models of acute pancreatitis;Barlass U;Gut,2018

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