Background and Objectives. Effective management of severe pain in acute pancreatitis is one of the important issues in therapy, as pain reflexes can contribute to the development of life-threatening secondary complications. Although opioid derivatives are still clinically in use, the direct interruption of afferent nociceptive visceral stimulation (e.g., by segmental epidural block) is claimed to be a much more effective method of pain relief. However, in a group of the patients with alcohol ingestion as the etiology of pancreatitis and history of drug/opioid addiction in the background, epidural block failed to alleviate the pain. Study aim was to assess the effect of continuous celiac plexus block as an alternative analgesic method in patients with acute pancreatitis by using a retrospective analysis.
Methods. Of 43 patients admitted to the intensive care unit with acute pancreatitis, 7 who did not respond to routine segmental T5-L2 epidural block received a continuous celiac plexus block performed in the right lateral position as an alternative method of pain relief.
Results. Intermittent or continuous injections of bupivacaine were administered for 96 hours or longer. During this time all the patients were pain-free while undergoing routine intensive care unit treatment. No side effects or complications due to this technique were observed apart from one unintentional vessel puncture during performance of the first block.
Conclusion. A continuous unilateral celiac plexus block offers an effective alternative treatment for pain in acute pancreatitis, especially in patients with alcohol etiology and history of drug/opioid addiction, in whom the conventional methods fail to give proper pain relief.
- acute pancreatitis
- alcohol etiology
- continuous celiac plexus
- drug/opioid addiction
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Informed consent from the patients and hospital ethics committee approval for the study was obtained.
The preliminary abstract of this study was presented in part at the 7th Annual Meeting of the European Society for Regional Anaesthesia, Mainz, Germany, October 1988.