The role of epidural anaesthesia in acute pancreatitis: Systematic Review of available evidence

ABSTRACT NUMBER: NESTAC MEDAL FOR MEDICAL STUDENTS_2

MAIN ABSTRACT TEXT

Introduction
Acute pancreatitis (AP) is a potentially life-threatening disease with a high mortality rate. This systematic review aimed to determine efficacy and complications following epidural anaesthesia (EA) in patients with AP.

Methods
PubMed, EMBASE, SCOPUS and Cochrane library databases were systematically searched between 1992 and 2022 using PRISMA guidelines, to identify studies observational or comparative studies reporting clinician, institutional, and regional experiences with EA in AP.

Results
Seven studies were included in this review, two randomised controlled trials (RCTs) and five retrospective studies with an overall study cohort comprising 566 patients that were administered EA for AP. All studies demonstrated safety and feasibility of EA in AP. EA related hypotension was observed in two studies, managed with fluid replacement and amines without complications. No local or neurological complications were encountered. One RCT demonstrated significant improvement in pancreatic perfusion compared with the non-EA group, 13 (43%) vs 2 (7%) (P=0.0025). No statistically significant difference was seen in the MODS and aggregate SOFA score. Two studies showed necrosectomy is less in EA groups 1 (7.6%) and 10 (22%) vs 4 (18.2%) 173 (19%) in non-EA groups P=0.63 and P=0.62, respectively. One RCT showed a propensity score analysis for 30-day mortality was lower in AP patients receiving EA (2% vs. 17%, p=0.01).

Conclusion
Early evidence suggests EA is safe and may have a role in reducing mortality and sequelae of AP however, larger randomised, prospective studies are needed to confirm the findings of this review.