Opioid analgesia and severity of acute pancreatitis: An international multicentre cohort study on pain management in acute pancreatitis
Background The effect of analgesic modalities on short‐term outcomes in acute pancreatitis remains unknown. However, preclinical models have raised safety concerns regarding opioid use in patients with acute pancreatitis. Objective This study aimed to assess the association between analgesics, parti...
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| Veröffentlicht in: | United European Gastroenterology Journal 2024-04, Vol.12 (3), p.326-338 |
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| creator | Pandanaboyana, Sanjay Knoph, Cecilie Siggaard Olesen, Søren Schou Jones, Michael Lucocq, James Samanta, Jayanta Talukdar, Rupjyoti Capurso, Gabriele de‐Madaria, Enrique Yadav, Dhiraj Siriwardena, Ajith K. Windsor, John Drewes, Asbjørn Mohr Nayar, Manu |
| description | Background
The effect of analgesic modalities on short‐term outcomes in acute pancreatitis remains unknown. However, preclinical models have raised safety concerns regarding opioid use in patients with acute pancreatitis.
Objective
This study aimed to assess the association between analgesics, particularly opioids, and severity and mortality in hospitalised patients with acute pancreatitis.
Methods
This prospective multicentre cohort study recruited consecutive patients admitted with a first episode of acute pancreatitis between April 1 and 30 June 2022, with a 1‐month follow‐up. Data on aetiology, clinical course, and analgesic treatment were collected. The primary outcome was the association between opioid analgesia and acute pancreatitis severity, which was analysed using univariate and multivariate analyses.
Results
Among a total of 1768 patients, included from 118 centres across 27 countries, 1036 (59%) had opioids administered on admission day, and 167 (9%) received opioids after admission day. On univariate analysis, moderately severe or severe acute pancreatitis was associated with male sex, Asian ethnicity, alcohol aetiology, comorbidity, predicted severe acute pancreatitis, higher pain scores, longer pain duration and opioid treatment (all p |
| doi_str_mv | 10.1002/ueg2.12542 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11017759</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A793590776</galeid><sourcerecordid>A793590776</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5162-714a3eb9f0dfa6e80d5f8eb1de6d33d88e4b94f241e0b9862caff33209cb5e9e3</originalsourceid><addsrcrecordid>eNp9kl1rFTEQhhdRbKm98QdIwBsRzjEf-xVv5FBqFQq9sdchm0xOU3aTY5JtOb_Av-20Ww8qYnKRYfK870zCVNVrRteMUv5hhi1fM97U_Fl1zGlDV23N6ueHmLZH1WnOtxRX39ec1y-rI9HXQnLKj6sfVzsfvSU66HEL2WuMLMlwB8mXPYmOaDMXIDsdTAJdfPH5I9kE4kOBFDARUUmmeSzeQCgJiIk3MRWSy2zRIKDUBzJhgS1MSKDyH56vqhdOjxlOn86T6vrz-bezL6vLq4uvZ5vLlWlYy1cdq7WAQTpqnW6hp7ZxPQzMQmuFsH0P9SBrx2sGdJB9y412TghOpRkakCBOqk-L724eJrCPLetR7ZKfdNqrqL368yb4G7WNd4oxyrqukejw7skhxe8z5KImnw2Mow4Q56y4FF1HW847RN_-hd7GGT9tzEpQiZsK2SC1XqitHkH54CIWNrgtTN7EAM5jftNJ0UjadS0K3i8Ck2LOCdyhfUbVw1Coh6FQj0OB8JvfH3xAf40AAmwB7rHM_j9W6vr8gi-mPwGZacSU</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3090900395</pqid></control><display><type>article</type><title>Opioid analgesia and severity of acute pancreatitis: An international multicentre cohort study on pain management in acute pancreatitis</title><source>MEDLINE</source><source>PMC (PubMed Central)</source><source>Wiley-Blackwell Full Collection</source><source>Wiley Open Access</source><creator>Pandanaboyana, Sanjay ; Knoph, Cecilie Siggaard ; Olesen, Søren Schou ; Jones, Michael ; Lucocq, James ; Samanta, Jayanta ; Talukdar, Rupjyoti ; Capurso, Gabriele ; de‐Madaria, Enrique ; Yadav, Dhiraj ; Siriwardena, Ajith K. ; Windsor, John ; Drewes, Asbjørn Mohr ; Nayar, Manu</creator><creatorcontrib>Pandanaboyana, Sanjay ; Knoph, Cecilie Siggaard ; Olesen, Søren Schou ; Jones, Michael ; Lucocq, James ; Samanta, Jayanta ; Talukdar, Rupjyoti ; Capurso, Gabriele ; de‐Madaria, Enrique ; Yadav, Dhiraj ; Siriwardena, Ajith K. ; Windsor, John ; Drewes, Asbjørn Mohr ; Nayar, Manu ; PAINAP Collaborative ; the PAINAP Collaborative</creatorcontrib><description>Background
The effect of analgesic modalities on short‐term outcomes in acute pancreatitis remains unknown. However, preclinical models have raised safety concerns regarding opioid use in patients with acute pancreatitis.
Objective
This study aimed to assess the association between analgesics, particularly opioids, and severity and mortality in hospitalised patients with acute pancreatitis.
Methods
This prospective multicentre cohort study recruited consecutive patients admitted with a first episode of acute pancreatitis between April 1 and 30 June 2022, with a 1‐month follow‐up. Data on aetiology, clinical course, and analgesic treatment were collected. The primary outcome was the association between opioid analgesia and acute pancreatitis severity, which was analysed using univariate and multivariate analyses.
Results
Among a total of 1768 patients, included from 118 centres across 27 countries, 1036 (59%) had opioids administered on admission day, and 167 (9%) received opioids after admission day. On univariate analysis, moderately severe or severe acute pancreatitis was associated with male sex, Asian ethnicity, alcohol aetiology, comorbidity, predicted severe acute pancreatitis, higher pain scores, longer pain duration and opioid treatment (all p < 0.001). On multivariate analysis, comorbidity, alcohol aetiology, longer pain duration and higher pain scores increased the risk of moderately severe or severe acute pancreatitis (all p < 0.001). Furthermore, opioids administered after admission day (but not on admission day) doubled the risk of moderately severe or severe disease (OR 2.07 (95% CI, 1.29–3.33); p = 0.003). Opioid treatment for 6 days or more was an independent risk factor for moderately severe or severe acute pancreatitis (OR 3.21 (95% CI, 2.16–4.79; p < 0.001). On univariate analysis, longer opioid duration was associated with mortality.
Conclusion
Opioid treatment increased the risk of more severe acute pancreatitis only when administered after admission day or for 6 days or more. Future randomised studies should re‐evaluate whether opioids might be safe in acute pancreatitis.</description><identifier>ISSN: 2050-6406</identifier><identifier>ISSN: 2050-6414</identifier><identifier>EISSN: 2050-6414</identifier><identifier>DOI: 10.1002/ueg2.12542</identifier><identifier>PMID: 38439202</identifier><language>eng</language><publisher>England: John Wiley & Sons, Inc</publisher><subject>Acute Disease ; acute pancreatitis ; alcoholic ; Analgesia ; Analgesics ; Analgesics - therapeutic use ; Analgesics, Opioid - adverse effects ; Analysis ; Care and treatment ; Chi-square test ; Cohort analysis ; Cohort Studies ; Comorbidity ; Cysts ; Health aspects ; Humans ; Intensive care ; Male ; Medical research ; Medicine, Experimental ; Morbidity ; Morphine ; Mortality ; Narcotics ; Necrosis ; Observational studies ; opioid ; Original ; Pain ; Pain Management ; Pancreas ; Pancreatitis ; Pancreatitis - diagnosis ; Pancreatitis - epidemiology ; Patients ; Prospective Studies ; R&D ; Research & development ; Research ethics ; Risk factors ; severity</subject><ispartof>United European Gastroenterology Journal, 2024-04, Vol.12 (3), p.326-338</ispartof><rights>2024 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.</rights><rights>COPYRIGHT 2024 John Wiley & Sons, Inc.</rights><rights>2024. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5162-714a3eb9f0dfa6e80d5f8eb1de6d33d88e4b94f241e0b9862caff33209cb5e9e3</citedby><cites>FETCH-LOGICAL-c5162-714a3eb9f0dfa6e80d5f8eb1de6d33d88e4b94f241e0b9862caff33209cb5e9e3</cites><orcidid>0000-0003-3916-3168 ; 0000-0003-3099-2197 ; 0000-0002-4255-6651 ; 0000-0001-7465-964X ; 0000-0002-8373-1487 ; 0000-0002-2412-9541 ; 0000-0002-0019-8753</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11017759/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11017759/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,1411,11541,27901,27902,45550,45551,46027,46451,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38439202$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pandanaboyana, Sanjay</creatorcontrib><creatorcontrib>Knoph, Cecilie Siggaard</creatorcontrib><creatorcontrib>Olesen, Søren Schou</creatorcontrib><creatorcontrib>Jones, Michael</creatorcontrib><creatorcontrib>Lucocq, James</creatorcontrib><creatorcontrib>Samanta, Jayanta</creatorcontrib><creatorcontrib>Talukdar, Rupjyoti</creatorcontrib><creatorcontrib>Capurso, Gabriele</creatorcontrib><creatorcontrib>de‐Madaria, Enrique</creatorcontrib><creatorcontrib>Yadav, Dhiraj</creatorcontrib><creatorcontrib>Siriwardena, Ajith K.</creatorcontrib><creatorcontrib>Windsor, John</creatorcontrib><creatorcontrib>Drewes, Asbjørn Mohr</creatorcontrib><creatorcontrib>Nayar, Manu</creatorcontrib><creatorcontrib>PAINAP Collaborative</creatorcontrib><creatorcontrib>the PAINAP Collaborative</creatorcontrib><title>Opioid analgesia and severity of acute pancreatitis: An international multicentre cohort study on pain management in acute pancreatitis</title><title>United European Gastroenterology Journal</title><addtitle>United European Gastroenterol J</addtitle><description>Background
The effect of analgesic modalities on short‐term outcomes in acute pancreatitis remains unknown. However, preclinical models have raised safety concerns regarding opioid use in patients with acute pancreatitis.
Objective
This study aimed to assess the association between analgesics, particularly opioids, and severity and mortality in hospitalised patients with acute pancreatitis.
Methods
This prospective multicentre cohort study recruited consecutive patients admitted with a first episode of acute pancreatitis between April 1 and 30 June 2022, with a 1‐month follow‐up. Data on aetiology, clinical course, and analgesic treatment were collected. The primary outcome was the association between opioid analgesia and acute pancreatitis severity, which was analysed using univariate and multivariate analyses.
Results
Among a total of 1768 patients, included from 118 centres across 27 countries, 1036 (59%) had opioids administered on admission day, and 167 (9%) received opioids after admission day. On univariate analysis, moderately severe or severe acute pancreatitis was associated with male sex, Asian ethnicity, alcohol aetiology, comorbidity, predicted severe acute pancreatitis, higher pain scores, longer pain duration and opioid treatment (all p < 0.001). On multivariate analysis, comorbidity, alcohol aetiology, longer pain duration and higher pain scores increased the risk of moderately severe or severe acute pancreatitis (all p < 0.001). Furthermore, opioids administered after admission day (but not on admission day) doubled the risk of moderately severe or severe disease (OR 2.07 (95% CI, 1.29–3.33); p = 0.003). Opioid treatment for 6 days or more was an independent risk factor for moderately severe or severe acute pancreatitis (OR 3.21 (95% CI, 2.16–4.79; p < 0.001). On univariate analysis, longer opioid duration was associated with mortality.
Conclusion
Opioid treatment increased the risk of more severe acute pancreatitis only when administered after admission day or for 6 days or more. Future randomised studies should re‐evaluate whether opioids might be safe in acute pancreatitis.</description><subject>Acute Disease</subject><subject>acute pancreatitis</subject><subject>alcoholic</subject><subject>Analgesia</subject><subject>Analgesics</subject><subject>Analgesics - therapeutic use</subject><subject>Analgesics, Opioid - adverse effects</subject><subject>Analysis</subject><subject>Care and treatment</subject><subject>Chi-square test</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Cysts</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Male</subject><subject>Medical research</subject><subject>Medicine, Experimental</subject><subject>Morbidity</subject><subject>Morphine</subject><subject>Mortality</subject><subject>Narcotics</subject><subject>Necrosis</subject><subject>Observational studies</subject><subject>opioid</subject><subject>Original</subject><subject>Pain</subject><subject>Pain Management</subject><subject>Pancreas</subject><subject>Pancreatitis</subject><subject>Pancreatitis - diagnosis</subject><subject>Pancreatitis - epidemiology</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>R&D</subject><subject>Research & development</subject><subject>Research ethics</subject><subject>Risk factors</subject><subject>severity</subject><issn>2050-6406</issn><issn>2050-6414</issn><issn>2050-6414</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kl1rFTEQhhdRbKm98QdIwBsRzjEf-xVv5FBqFQq9sdchm0xOU3aTY5JtOb_Av-20Ww8qYnKRYfK870zCVNVrRteMUv5hhi1fM97U_Fl1zGlDV23N6ueHmLZH1WnOtxRX39ec1y-rI9HXQnLKj6sfVzsfvSU66HEL2WuMLMlwB8mXPYmOaDMXIDsdTAJdfPH5I9kE4kOBFDARUUmmeSzeQCgJiIk3MRWSy2zRIKDUBzJhgS1MSKDyH56vqhdOjxlOn86T6vrz-bezL6vLq4uvZ5vLlWlYy1cdq7WAQTpqnW6hp7ZxPQzMQmuFsH0P9SBrx2sGdJB9y412TghOpRkakCBOqk-L724eJrCPLetR7ZKfdNqrqL368yb4G7WNd4oxyrqukejw7skhxe8z5KImnw2Mow4Q56y4FF1HW847RN_-hd7GGT9tzEpQiZsK2SC1XqitHkH54CIWNrgtTN7EAM5jftNJ0UjadS0K3i8Ck2LOCdyhfUbVw1Coh6FQj0OB8JvfH3xAf40AAmwB7rHM_j9W6vr8gi-mPwGZacSU</recordid><startdate>202404</startdate><enddate>202404</enddate><creator>Pandanaboyana, Sanjay</creator><creator>Knoph, Cecilie Siggaard</creator><creator>Olesen, Søren Schou</creator><creator>Jones, Michael</creator><creator>Lucocq, James</creator><creator>Samanta, Jayanta</creator><creator>Talukdar, Rupjyoti</creator><creator>Capurso, Gabriele</creator><creator>de‐Madaria, Enrique</creator><creator>Yadav, Dhiraj</creator><creator>Siriwardena, Ajith K.</creator><creator>Windsor, John</creator><creator>Drewes, Asbjørn Mohr</creator><creator>Nayar, Manu</creator><general>John Wiley & Sons, Inc</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IAO</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-3916-3168</orcidid><orcidid>https://orcid.org/0000-0003-3099-2197</orcidid><orcidid>https://orcid.org/0000-0002-4255-6651</orcidid><orcidid>https://orcid.org/0000-0001-7465-964X</orcidid><orcidid>https://orcid.org/0000-0002-8373-1487</orcidid><orcidid>https://orcid.org/0000-0002-2412-9541</orcidid><orcidid>https://orcid.org/0000-0002-0019-8753</orcidid></search><sort><creationdate>202404</creationdate><title>Opioid analgesia and severity of acute pancreatitis: An international multicentre cohort study on pain management in acute pancreatitis</title><author>Pandanaboyana, Sanjay ; Knoph, Cecilie Siggaard ; Olesen, Søren Schou ; Jones, Michael ; Lucocq, James ; Samanta, Jayanta ; Talukdar, Rupjyoti ; Capurso, Gabriele ; de‐Madaria, Enrique ; Yadav, Dhiraj ; Siriwardena, Ajith K. ; Windsor, John ; Drewes, Asbjørn Mohr ; Nayar, Manu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5162-714a3eb9f0dfa6e80d5f8eb1de6d33d88e4b94f241e0b9862caff33209cb5e9e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Acute Disease</topic><topic>acute pancreatitis</topic><topic>alcoholic</topic><topic>Analgesia</topic><topic>Analgesics</topic><topic>Analgesics - therapeutic use</topic><topic>Analgesics, Opioid - adverse effects</topic><topic>Analysis</topic><topic>Care and treatment</topic><topic>Chi-square test</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Comorbidity</topic><topic>Cysts</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Intensive care</topic><topic>Male</topic><topic>Medical research</topic><topic>Medicine, Experimental</topic><topic>Morbidity</topic><topic>Morphine</topic><topic>Mortality</topic><topic>Narcotics</topic><topic>Necrosis</topic><topic>Observational studies</topic><topic>opioid</topic><topic>Original</topic><topic>Pain</topic><topic>Pain Management</topic><topic>Pancreas</topic><topic>Pancreatitis</topic><topic>Pancreatitis - diagnosis</topic><topic>Pancreatitis - epidemiology</topic><topic>Patients</topic><topic>Prospective Studies</topic><topic>R&D</topic><topic>Research & development</topic><topic>Research ethics</topic><topic>Risk factors</topic><topic>severity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pandanaboyana, Sanjay</creatorcontrib><creatorcontrib>Knoph, Cecilie Siggaard</creatorcontrib><creatorcontrib>Olesen, Søren Schou</creatorcontrib><creatorcontrib>Jones, Michael</creatorcontrib><creatorcontrib>Lucocq, James</creatorcontrib><creatorcontrib>Samanta, Jayanta</creatorcontrib><creatorcontrib>Talukdar, Rupjyoti</creatorcontrib><creatorcontrib>Capurso, Gabriele</creatorcontrib><creatorcontrib>de‐Madaria, Enrique</creatorcontrib><creatorcontrib>Yadav, Dhiraj</creatorcontrib><creatorcontrib>Siriwardena, Ajith K.</creatorcontrib><creatorcontrib>Windsor, John</creatorcontrib><creatorcontrib>Drewes, Asbjørn Mohr</creatorcontrib><creatorcontrib>Nayar, Manu</creatorcontrib><creatorcontrib>PAINAP Collaborative</creatorcontrib><creatorcontrib>the PAINAP Collaborative</creatorcontrib><collection>Wiley Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Academic OneFile</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content (ProQuest)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>United European Gastroenterology Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pandanaboyana, Sanjay</au><au>Knoph, Cecilie Siggaard</au><au>Olesen, Søren Schou</au><au>Jones, Michael</au><au>Lucocq, James</au><au>Samanta, Jayanta</au><au>Talukdar, Rupjyoti</au><au>Capurso, Gabriele</au><au>de‐Madaria, Enrique</au><au>Yadav, Dhiraj</au><au>Siriwardena, Ajith K.</au><au>Windsor, John</au><au>Drewes, Asbjørn Mohr</au><au>Nayar, Manu</au><aucorp>PAINAP Collaborative</aucorp><aucorp>the PAINAP Collaborative</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Opioid analgesia and severity of acute pancreatitis: An international multicentre cohort study on pain management in acute pancreatitis</atitle><jtitle>United European Gastroenterology Journal</jtitle><addtitle>United European Gastroenterol J</addtitle><date>2024-04</date><risdate>2024</risdate><volume>12</volume><issue>3</issue><spage>326</spage><epage>338</epage><pages>326-338</pages><issn>2050-6406</issn><issn>2050-6414</issn><eissn>2050-6414</eissn><abstract>Background
The effect of analgesic modalities on short‐term outcomes in acute pancreatitis remains unknown. However, preclinical models have raised safety concerns regarding opioid use in patients with acute pancreatitis.
Objective
This study aimed to assess the association between analgesics, particularly opioids, and severity and mortality in hospitalised patients with acute pancreatitis.
Methods
This prospective multicentre cohort study recruited consecutive patients admitted with a first episode of acute pancreatitis between April 1 and 30 June 2022, with a 1‐month follow‐up. Data on aetiology, clinical course, and analgesic treatment were collected. The primary outcome was the association between opioid analgesia and acute pancreatitis severity, which was analysed using univariate and multivariate analyses.
Results
Among a total of 1768 patients, included from 118 centres across 27 countries, 1036 (59%) had opioids administered on admission day, and 167 (9%) received opioids after admission day. On univariate analysis, moderately severe or severe acute pancreatitis was associated with male sex, Asian ethnicity, alcohol aetiology, comorbidity, predicted severe acute pancreatitis, higher pain scores, longer pain duration and opioid treatment (all p < 0.001). On multivariate analysis, comorbidity, alcohol aetiology, longer pain duration and higher pain scores increased the risk of moderately severe or severe acute pancreatitis (all p < 0.001). Furthermore, opioids administered after admission day (but not on admission day) doubled the risk of moderately severe or severe disease (OR 2.07 (95% CI, 1.29–3.33); p = 0.003). Opioid treatment for 6 days or more was an independent risk factor for moderately severe or severe acute pancreatitis (OR 3.21 (95% CI, 2.16–4.79; p < 0.001). On univariate analysis, longer opioid duration was associated with mortality.
Conclusion
Opioid treatment increased the risk of more severe acute pancreatitis only when administered after admission day or for 6 days or more. Future randomised studies should re‐evaluate whether opioids might be safe in acute pancreatitis.</abstract><cop>England</cop><pub>John Wiley & Sons, Inc</pub><pmid>38439202</pmid><doi>10.1002/ueg2.12542</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0003-3916-3168</orcidid><orcidid>https://orcid.org/0000-0003-3099-2197</orcidid><orcidid>https://orcid.org/0000-0002-4255-6651</orcidid><orcidid>https://orcid.org/0000-0001-7465-964X</orcidid><orcidid>https://orcid.org/0000-0002-8373-1487</orcidid><orcidid>https://orcid.org/0000-0002-2412-9541</orcidid><orcidid>https://orcid.org/0000-0002-0019-8753</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 2050-6406 |
| ispartof | United European Gastroenterology Journal, 2024-04, Vol.12 (3), p.326-338 |
| issn | 2050-6406 2050-6414 2050-6414 |
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| source | MEDLINE; PMC (PubMed Central); Wiley-Blackwell Full Collection; Wiley Open Access |
| subjects | Acute Disease acute pancreatitis alcoholic Analgesia Analgesics Analgesics - therapeutic use Analgesics, Opioid - adverse effects Analysis Care and treatment Chi-square test Cohort analysis Cohort Studies Comorbidity Cysts Health aspects Humans Intensive care Male Medical research Medicine, Experimental Morbidity Morphine Mortality Narcotics Necrosis Observational studies opioid Original Pain Pain Management Pancreas Pancreatitis Pancreatitis - diagnosis Pancreatitis - epidemiology Patients Prospective Studies R&D Research & development Research ethics Risk factors severity |
| title | Opioid analgesia and severity of acute pancreatitis: An international multicentre cohort study on pain management in acute pancreatitis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-07T16%3A56%3A06IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Opioid%20analgesia%20and%20severity%20of%20acute%20pancreatitis:%20An%20international%20multicentre%20cohort%20study%20on%20pain%20management%20in%20acute%20pancreatitis&rft.jtitle=United%20European%20Gastroenterology%20Journal&rft.au=Pandanaboyana,%20Sanjay&rft.aucorp=PAINAP%20Collaborative&rft.date=2024-04&rft.volume=12&rft.issue=3&rft.spage=326&rft.epage=338&rft.pages=326-338&rft.issn=2050-6406&rft.eissn=2050-6414&rft_id=info:doi/10.1002/ueg2.12542&rft_dat=%3Cgale_pubme%3EA793590776%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3090900395&rft_id=info:pmid/38439202&rft_galeid=A793590776&rfr_iscdi=true |