S216 Morphine Use and Clinical Outcomes in Acute Pancreatitis: A Retrospective Cohort Study

Introduction: The safety of morphine in acute pancreatitis (AP) remains debated due to theoretical risks of exacerbating complications. This study evaluated whether early morphine use correlates with clinical deterioration in AP. Methods: In this retrospective cohort study, 154 patients with AP (diagnosed per Revised Atlanta Criteria) treated at a tertiary center (2012 to 2024) were stratified by morphine use within 48 hours of admission. Outcomes included clinical deterioration (30-day mortality, mechanical ventilation, vasopressor use, surgery, prolonged hospitalization, CRP doubling, or new organ failure). Logistic regression models were adjusted for age, sex, disease severity, ICU admission, and inflammatory markers. Results: Of 154 patients, 53 received early morphine. Baseline characteristics showed no age/sex differences, but morphine recipients had lower mechanical ventilation rates (17.0% vs 35.6%, P = 0.02) and higher hemoglobin (131.0 vs 122.0 g/L, P = 0.01). Clinical deterioration occurred in 49.1% (morphine) vs 62.4% (non-morphine), with no significant difference (adjusted odds ratio = 0.61, 95% CI: 0.29–1.28, P = 0.19). High-dose opioids (MME ≥100, n = 24) showed no association with deterioration (P > 0.05). Severity-adjusted analyses confirmed these findings. Conclusion: Early morphine/Opioids use in AP was not associated with increased risk of clinical deterioration, even at higher doses. These findings challenge historical concerns and support cautious opioid analgesia in AP, though prospective trials are needed to confirm safety.