medigraphic.com
Colegio de Medicina Interna de México.

2015, Number 4

<< Back Next >>

Med Int Mex 2015; 31 (4)

Management of severe acute pancreatitis with epidural blockade

Carrillo-Esper R, Pineda-Castillejos JL, Lazcano-Romano I

Language: Spanish
References: 22
Page: 472-477
PDF size: 465.86 Kb.


ABSTRACT

Epidural blockade (EB) is a therapeutic strategy poorly evaluated in acute pancreatitis that impacts on pain control and maintenance of splanchnic blood flow and pancreatic microcirculation. This paper reports the case of a 30-year-old male patient who entered with severe acute pancreatitis and severe abdominal pain despite treatment with systemic analgesics. Epidural blockade was performed at L1-L2 directed with a cephalic catheter and infusion was started based on bupivacaine and fentanyl. After starting the infusion, pain referred and systemic and local manifestations of the severe acute pancreatitis were controlled. There is no consensus for the use of epidural blockade in patients with severe acute pancreatitis; however, it has been observed in experimental studies and small clinical studies that the use of epidural blockade in severe acute pancreatitis controls pain and impacts positively on splanchnic perfusion and pancreatic blood flow. It requires controlled clinical studies to validate this therapeutic alternative.


REFERENCES

  1. Browne R, Ashworth E. The use of epidural block in acute pancreatitis: a report of eight cases. Can Anaesth Soc J 1969;16:416-424.

  2. Página de la Secretaría de Salud. Información Estadística y Egresos Hospitalarios. http://www.sinais.salud.gob.mx/descargas/pdf/lista_mexicana.pdf

  3. Banks PA. Acute pancreatitis: medical and surgical management. Am J Gastroenterol 1994;89:78-85.

  4. Bernhardt A, Kortgen A, Niesel H, Goertz A. Using epidural anesthesia in pancreatitis with acute pancreatitis–prospective study of 121 patients. Anaesthesiol Reanim 2002;27:16-22.

  5. Sielenkämper AW, Eicker K, Van Aken H. Thoracic epidural anesthesia increases mucosal perfusion in ileum of rats. Anesthesiology 2001;94:263-269.

  6. Johnson CD, Abu-Hilal M. Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis. Gut 2004;53:1340-1344.

  7. Cruz-Santamaría D, Taxonera C, Giner M. Update on pathogenesis and clinical management of acute pancreatitis. World J Gastrointest Pathophysiol 2012;3:60-70.

  8. Kuroda A, Nagai H. Surgical anatomy of the pancreas. In: Howard JM, Idezuki Y, Ihse I, Prinz RA, editors. Surgical diseases of the pancreas, 3rd ed. Baltimore: Williams and Wilkins, 1998;11-21.

  9. Freise H, Lauer S, Konietzny E, Hinkelmann J, et al. Hepatic effects of thoracic epidural analgesia in experimental severe acute pancreatitis. Anesthesiology 2009;111:1249-1256.

  10. Cuthbertson CM, Chritophi C. Disturbances of the microcirculation in acute pancreatitis. Br J Surg 2006;93:518-530.

  11. Harper D, McNaught C. The role of thoracic epidural anesthesia in severe acute pancreatitis. Crit Care 2014;18:106-107.

  12. Bachmann KA, Trepte CJC, Tomkötter L, Hinsch A, et al. Effects of thoracic epidural anaesthesia on survival and microcirculation in severe acute pancreatitis: a randomized experimental trial. Crit Care 2013;17:281.

  13. Gould TH, Grace K, Thorne G, Thomas M. Effect of thoracic epidural anaesthesia on colonic blood flow. Br J Anaesth 2002;89:446-451.

  14. Lundberg J, Lundberg D, Norgren L, Ribbe E, et al. Intestinal haemodynamics during laparotomy: effects of thoracic epidural anaesthesia and dopamine in humans. Anaesth Analg 1990;71:9-15.

  15. Michelet P, Roch A, D’Journo XB, Blayac D, et al. Effect of thoracic epidural analgesia on gastric blood flow after oesophagectomy. Acta Anaesthesiol Scand 2007;51:487-594.

  16. Kortgen A, Silomon M, Pape-Becker C, Buchinger H, et al. Thoracic but not lumbar epidural anaesthesia increases liver blood flow after major abdominal surgery. Eur J Anaesthesiol 2009;26:111-116.

  17. Väisänen O, Parviainen I, Ruokonen E, Hippeläinen M, et al. Epidural analgesia with bupivacaine does not improve splanchnic tissue perfusión after aortic reconstruction surgery. Br J Anaesth 1998;81:893-898.

  18. Richards ER, Kabir SI, McNaught CE, MacFie J. Effect of thoracic epidural anaesthesia on splanchnic blood flow. Br J Surg 2013;100:316-321.

  19. Adolphs J, Schmidt DK, Korsukewitz I, Kamin B, et al. Effects of thoracic epidural anaesthesia on intestinal microvascular perfusion in a rodent model of normotensive endotoxaemia. Intensive Care Med 2004;30:2094-2101.

  20. Steinbrook RA. Epidural anaesthesia and gastrointestinal motility. Anesth Analg 1998;175:76-83.

  21. Demirag A, Pastor C, Morel P, Jean-Christophe C, et al. Epidural anaesthesia restores pancreatic microcirculation and decreases the severity of acute pancreatitis. World J Gastroenterol 2006;12:915-920.

  22. Bernhardt A, Kortgen A, Niesel HCh, Goertz A. Using epidural anesthesia in patients with acute pancreatitis–prospective study of 121 patientes. Anaesthesiol Reanim 2002;27:16-22.




2020     |     www.medigraphic.com