Role of thoracic epidural analgesia in moderate-to-severe acute pancreatitis: A prospective cohort trial

Background: Acute pancreatitis (AP) is often accompanied by a significant stress response to pain, which compounds the systemic inflammatory response syndrome and multiple organ failures. Aims and Objectives: This study aims to investigate the efficacy of thoracic epidural analgesia (TEA) in reducing the stress response to pain in patients with moderately severe and severe AP, potentially enhancing patient recovery. The primary outcome measures are pain control, duration of intensive care unit (ICU) stay, and ventilator requirement. Materials and Methods: This is a prospective cohort study from a gastrointestinal surgery unit in a tertiary care center. After informed consent, patients with moderately severe and severe AP diagnosed by clinical, biochemical, and radiological criteria were allocated into two groups. The test group receives epidural analgesia along with standard care. The control group receives standard medical management alone. Patients with refractory hypotension, uncorrectable coagulopathy, and shock are excluded from the study. Patients in both groups were followed for 1 month to record clinical parameters. Results: Among the 44 patients (22 epidural and 22 conservative), the epidural group demonstrated significantly longer pain-free duration, shorter ICU stay, early tolerance to enteral feeding, reduced oxygen requirement, and much faster declining C-reactive protein levels. Mechanical ventilation requirement was more frequent in the control group, though duration was comparable. Mortality and total hospital stay showed no significant difference. Conclusion: TEA shortened pain duration, ICU stay, and need for ventilator requirement. TEA enabled early alimentation and without significantly affecting hospital stay or mortality. Larger randomized trials are needed to confirm these findings.