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Multicenter Study
. 2024 Apr;12(3):326-338.
doi: 10.1002/ueg2.12542. Epub 2024 Mar 4.

Opioid analgesia and severity of acute pancreatitis: An international multicentre cohort study on pain management in acute pancreatitis

Sanjay Pandanaboyana  1   2 , Cecilie Siggaard Knoph  3   4 , Søren Schou Olesen  3   4 , Michael Jones  1 , James Lucocq  5 , Jayanta Samanta  6 , Rupjyoti Talukdar  7 , Gabriele Capurso  8 , Enrique de-Madaria  9 , Dhiraj Yadav  10 , Ajith K Siriwardena  11 , John Windsor  12 , Asbjørn Mohr Drewes  3   4 , Manu Nayar  1   2 ; PAINAP Collaborative
Collaborators, Affiliations
Multicenter Study

Opioid analgesia and severity of acute pancreatitis: An international multicentre cohort study on pain management in acute pancreatitis

Sanjay Pandanaboyana et al. United European Gastroenterol J. 2024 Apr.

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.

Keywords: acute pancreatitis; alcoholic; analgesia; morbidity; mortality; opioid; pain; severity.

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Conflict of interest statement

None to declare.

Figures

FIGURE 1
FIGURE 1
Conceptual model explaining the temporal association between exposure and outcomes in this study. AP = acute pancreatitis.
FIGURE 2
FIGURE 2
Flowchart for the patients included in the study and stratification based on the timing of opioid administration.
FIGURE 3
FIGURE 3
The proportion of patients with moderately severe or severe AP stratified according to pain severity (a), pain duration (b), timing of opioid administration (c) and the duration of opioid treatment (d). AP = acute pancreatitis.
FIGURE 4
FIGURE 4
Forest plot illustrating the odds ratios for the risk of developing moderately severe or severe acute pancreatitis (AP) based on the timing of opioid administration (a) and the duration of opioid treatment (b) (multivariate analyses). CCI, Charlson Comorbidity Index; NRS, Numeric Rating Scale; CI, confidence interval.
See this image and copyright information in PMC

Comment in

References

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