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Epidural analgesia or opiates for pain control in acute pancreatitis

Three Part Question

In [patients with acute pancreatitis with severe GI symptoms], is [epidural analgesia (opiate and/or local anaesthetics) better than intravenous opiate] in [controlling pain]?

Clinical Scenario

A 51 year old male attends the accident and emergency department with acute severe epigastric pain. After carrying out a few diagnostic tests, he is diagnosed with acute pancreatitis.
You wonder if epidural analgesia might be better than intravenous morphine in controlling pain in this patient.

Search Strategy

Medline 1966 to June Week 4 2006 using Ovid Interface, Embase and CINAHL.
The Cochrane Library and the National Library of Health were also used.
([ or exp Pancreatitis, Acute Necrotizing/ or exp Pancreatitis/ or exp Pancreatitis, Alcoholic/] AND [exp Injections, Epidural/ or exp Anesthesia, Epidural/ or exp Analgesia, Epidural/ or] AND [ or exp Narcotics/])

Search Outcome

21 papers were found in total, none was relevant.


No evidence comparing epidural analgesia and intravenous opioids were found despite a detailed search conducted.

Clinical Bottom Line

Opioids administered intravenously is an effective management for severe pain in acute pancreatitis and may be a more favourable pain management in the accident and emergency department.