Bobak Moazzami, MD1, Zinat Mohammadpour, PhD2, Zohyra Zabala, MD3, Saurabh Chawla, MD4 1Northside Hospital Gwinnett, Atlanta, GA; 2College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia; 3St. Barnabas Hospital, Bronx, NY; 4Emory University School of Medicine, Atlanta, GA
Introduction: Acute pancreatitis (AP) is associated with severe complications and high mortality. Previous studies have indicated that epidural analgesia (EA), beyond its role in pain management, can reduce AP severity and improve outcomes. The present systematic review and meta-analysis aimed to evaluate the efficacy of EA on in-hospital outcomes in AP patients.
Methods: PubMed, Medline-Ovid, Scopus, CINAHL, and Web of Science databases were systematically searched up to mid-May 2024, following PRISMA guidelines, to identify randomized controlled trials on EA in AP. Data were extracted and risk of bias was assessed by two independent reviewers. Meta-analysis was conducted using Cochrane RevMan software to evaluate the efficacy of EA on in-hospital outcomes in AP patients.
Results: Five RCTs with 260 participants were included. Meta-analysis revealed no significant differences in in-hospital mortality (RR = 0.69, 95% CI [0.29, 1.65], p = 0.40), ventilation needs (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). Heterogeneity was low to moderate for most outcomes but high for pain score (I2 = 92%). The overall certainty of evidence was judged to be very low due to the small number of studies, high risk of bias, and limited sample size.
Discussion: Epidural analgesia did not significantly improve in-hospital outcomes in patients with AP. These findings highlight the need for further high-quality, large-scale randomized trials to better understand the potential benefits of EA in this population.
Figure: Figure 1. Forest plot for the pooled odds ratio of the effect of epidural analgesia on in-hospital outcomes in patients with acute pancreatitis using random-effect model.
Disclosures:
Bobak Moazzami indicated no relevant financial relationships.
Zinat Mohammadpour indicated no relevant financial relationships.
Zohyra Zabala indicated no relevant financial relationships.
Saurabh Chawla indicated no relevant financial relationships.
Bobak Moazzami, MD1, Zinat Mohammadpour, PhD2, Zohyra Zabala, MD3, Saurabh Chawla, MD4. P0046 - The Effect of Epidural Analgesia on In-Hospital Outcomes in Patients With Acute Pancreatitis: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
