Possibilities for pain relief in acute pancreatitis: a narrative review

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Currently, there are no recommendations for managing pain syndrome in patients with acute destructive pancreatitis. A literature search was conducted using PubMed, Cochrane Controlled Clinical Trials Register, and Google Scholar, without restrictions on language, type, or date of the publication. The analysis revealed several possible options for anesthesia in acute destructive pancreatitis. The most commonly used methods for pain relief include narcotic analgesics and nonsteroidal anti-inflammatory drugs. However, in severe forms of acute pancreatitis, nonsteroidal anti-inflammatory drugs should be used with caution due to the risk of acute kidney injury, while opiates may adversely affect the sphincter of Oddi and contribute to the disease progression due to increased ductal pressure. Epidural analgesia also presents limitations, such as risks of hypotension and incompatibility with anticoagulant or antiplatelet therapy. As alternatives, regional anesthesia techniques (paravertebral block and erector spinae plane block) should be considered. Choosing an optimal analgesia method should take into account several factors: pain intensity, disease severity, etiology of acute destructive pancreatitis, comorbidities, and concurrent use of anticoagulants and antiplatelets. Further research into effectiveness of regional analgesia methods is warranted, as they may address both somatic and visceral components of pain and may prove effective and safe in the most severe cases.

作者简介

Denis Tsvetkov

Odintsovo Regional Hospital; Vladimirsky Moscow Regional Research and Clinical Institute

编辑信件的主要联系方式.
Email: tsvetkov75@gmail.com
ORCID iD: 0000-0003-1905-8627

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Odintsovo; Moscow

Denis Protsenko

Pirogov Russian National Research Medical University; Moscow’s Multidisciplinary Clinical Center “Kommunarka”

Email: drprotsenko@me.com
ORCID iD: 0000-0002-5166-3280
SPIN 代码: 1019-8216

MD, Dr. Sci. (Medicine), Аssociate Рrofessor

俄罗斯联邦, Moscow; Moscow

Efim Shifman

Vladimirsky Moscow Regional Research and Clinical Institute; Pirogov Russian National Research Medical University

Email: Eshifman@mail.ru
ORCID iD: 0000-0002-6113-8498
SPIN 代码: 4582-8494

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Moscow; Moscow

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