Use of epidural analgesia in patients with critically acute pancreatitis may reduce 30-day mortality rates compared with the absence of a pain management strategy, according to a multicenter retrospective observational study published in Critical Care Medicine.
Researchers evaluated mortality data for patients admitted to 17 French and Belgian intensive care units for acute pancreatitis between 2009 and 2014. Patients receiving thoracic epidural analgesia (n=46) were compared with patients receiving standard care without epidural analgesia (n=957).
A total of 212 patients from the entire cohort died within 30 days of intensive care unit admission. In an unadjusted analysis, epidural analgesia was associated with a lower rate of 30-day mortality compared with standard care (4% vs 22%, respectively; P =.003). After adjustment for several mortality-related baseline variables, the association between epidural analgesia and lower mortality rates persisted (adjusted odds ratio, 0.10; 95% CI, 0.02-0.49; P =.004).
A propensity score analysis indicated that all-cause 30-day mortality in patients with acute pancreatitis who had received epidural analgesia was still lower than in matched patients who had received standard care and no epidural analgesia (2% vs 17%, respectively; P =.01).
Because of the study’s retrospective nature, the investigators suggest the possibility of bias with regard to the detection of baseline clinical variables and outcomes. In addition, the researchers were unable to evaluate the association between epidural analgesia timing and clinical outcome.
The investigators report that the “5-year study period was representative of contemporary practice in [acute pancreatitis] management,” strengthening the clinical relevance of the findings.
Jabaudon M, Belhadj-Tahar N, Rimmelé T, et al. Thoracic epidural analgesia and mortality in acute pancreatitis: A multicenter propensity analysis [published online November 30, 2017]. Crit Care Med. doi:10.1097/CCM.0000000000002874