Background and Goal of Study:The aim of our study was to compare epidural analgesia with bupivacaine to morphine subcutaneously in the management of severe acute pancreatitis (SAP).

Materials and Methods: Prospective study conducted between March 2012 and October 2015. We included 84 patients admitted for PAG. We excluded all patients who presented hemodynamic instability or altered mental status. We randomize the patients into 2 groups: group A, patients received epidural thoracic analgesia with 6ml of isobaric bupivacaine 0,125% per hour and group B, a morphine analgesia subcutaneously at the dose of 5 mg every 6 hours. We compared the two groups during the first 5 days, the level of analgesia using a visual analog scale (VAS) every 3 hours, temperature and blood glucose finger (GAD) every 4 hours and ileus daily, white blood cells rate (BC), CRP and creatinine every day and does the chest radiograph every day and the 10th day scannographic score. Furthermore, we noted the complications (infection and multiple organ failure), length of hospital stay and mortality.

Results and Discussion:we included 84 patients divided into 2 equal groups. The average age is 62.23 years, body mass index is 27.4 and the sex ratio was 1.9. The mean VAS is 24,7mm in group A and 31.8

mm	in group B with p = 0.024. The average temperature is 37.7 ° C in group A versus 38.1 ° C in B with p = 0.039 and that of glucose is 1.31 in group A versus B in 1.44 with p = 0.025. The average duration of ileus is 50.4 hours, while it is 68.9 hours in Group B with p = 0.012. No significant difference between the 2 groups in mean WBC and creatinine while the average CRP is 66,4mg in Group A against B in 88,9mg with p = 0.011. 17 patients had pleural effusion of average abundance in Group B against only 6 in group A (p = 0.021). we noted a scannographic improvement in 33 patients (77%) against 25 patients (60%) in group B with p = 0.039. The hospital stay is 17,4jours in group A versus 21.6 days in group B with p = .028. No difference between the 2 groups with respect to mortality.

Conclusion: epidural analgesia, through its analgesic and anti-inflammatory, could improve the management of SAP.

References :Alp Demirag et al. Epidural anaesthesia restores pancreatic microcirculation and decreases the severity of acute pancreatitis. World J Gastroenterol 2006.14; 12(6): 915-920.


12 / Epidural analgesia contribution in the manegement of severe acute pancreatitis.