title: Epidural anesthesia improves pancreatic perfusion and decreases the severity of acute pancreatitis.
abstract: OBJECTIVE
  To study the safety of epidural anesthesia (EA), its effect on pancreatic perfusion and the outcome of patients with acute pancreatitis (AP).
  
  
  METHODS
  From 2005 to August 2010, patients with predicted severe AP [Ranson score ≥ 2, C-reactive protein > 100 or necrosis on computed tomography (CT)] were prospectively randomized to either a group receiving EA or a control group treated by patient controlled intravenous analgesia. Pain management was evaluated in the two groups every eight hours using the visual analog pain scale (VAS). Parameters for clinical severity such as length of hospital stay, use of antibiotics, admission to the intensive care unit, radiological/clinical complications and the need for surgical necrosectomy including biochemical data were recorded. A CT scan using a perfusion protocol was performed on admission and at 72 h to evaluate pancreatic blood flow. A significant variation in blood flow was defined as a 20% difference in pancreatic perfusion between admission and 72 h and was measured in the head, body and tail of the pancreas.
  
  
  RESULTS
  We enrolled 35 patients. Thirteen were randomized to the EA group and 22 to the control group. There were no differences in demographic characteristics between the two groups. The Balthazar radiological severity score on admission was higher in the EA group than in the control group (mean score 4.15 ± 2.54 vs 3.38 ± 1.75, respectively, P = 0.347) and the median Ranson scores were 3.4 and 2.7 respectively (P = NS). The median duration of EA was 5.7 d, and no complications of the epidural procedure were reported. An improvement in perfusion of the pancreas was observed in 13/30 (43%) of measurements in the EA group vs 2/27 (7%) in the control group (P = 0.0025). Necrosectomy was performed in 1/13 patients in the EA group vs 4/22 patients in the control group (P = 0.63). The VAS improved during the first ten days in the EA group compared to the control group (0.2 vs 2.33, P = 0.034 at 10 d). Length of stay and mortality were not statistically different between the 2 groups (26 d vs 30 d, P = 0.65, and 0% for both respectively).
  
  
  CONCLUSIONS
  Our study demonstrates that EA increases arterial perfusion of the pancreas and improves the clinical outcome of patients with AP.
authors.affiliation: Samira M Sadowski, Axel Andres, Philippe Morel, Leo Bühler, Department of Visceral and Transplantation Surgery, University Hospitals of Geneva, 1211 Geneva 14, Switzerland.
authors.forename: Samira M
authors.initials: SM
authors.lastname: Sadowski
authors.affiliation: Samira M Sadowski, Axel Andres, Philippe Morel, Leo Bühler, Department of Visceral and Transplantation Surgery, University Hospitals of Geneva, 1211 Geneva 14, Switzerland.
authors.forename: Axel
authors.initials: A
authors.lastname: Andres
authors.affiliation: Samira M Sadowski, Axel Andres, Philippe Morel, Leo Bühler, Department of Visceral and Transplantation Surgery, University Hospitals of Geneva, 1211 Geneva 14, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
authors.affiliation: Samira M Sadowski, Axel Andres, Philippe Morel, Leo Bühler, Department of Visceral and Transplantation Surgery, University Hospitals of Geneva, 1211 Geneva 14, Switzerland.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Schiffer
authors.affiliation: Samira M Sadowski, Axel Andres, Philippe Morel, Leo Bühler, Department of Visceral and Transplantation Surgery, University Hospitals of Geneva, 1211 Geneva 14, Switzerland.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Frossard
authors.affiliation: Samira M Sadowski, Axel Andres, Philippe Morel, Leo Bühler, Department of Visceral and Transplantation Surgery, University Hospitals of Geneva, 1211 Geneva 14, Switzerland.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Platon
authors.affiliation: Samira M Sadowski, Axel Andres, Philippe Morel, Leo Bühler, Department of Visceral and Transplantation Surgery, University Hospitals of Geneva, 1211 Geneva 14, Switzerland.
authors.forename: Pierre-Alexandre
authors.initials: PA
authors.lastname: Poletti
authors.affiliation: Samira M Sadowski, Axel Andres, Philippe Morel, Leo Bühler, Department of Visceral and Transplantation Surgery, University Hospitals of Geneva, 1211 Geneva 14, Switzerland.
authors.forename: Leo
authors.initials: L
authors.lastname: Bühler
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D000208:Acute Disease; D000368:Aged; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000767:Anesthesia, Epidural / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D004338:Drug Combinations; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009336:Necrosis; D010147:Pain Measurement; D010179:Pancreas / Q000098:blood supply / Q000000981:diagnostic imaging / Q000187:drug effects*; D010195:Pancreatitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D055420:Perfusion Imaging / Q000379:methods; D010865:Pilot Projects; D020127:Recovery of Function; D012039:Regional Blood Flow; D012720:Severity of Illness Index; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D004338:Drug Combinations; D005283:Fentanyl; D002045:Bupivacaine
keywords: Computed tomography; Epidural anesthesia; Pancreatic necrosectomy; Pancreatic perfusion; Severe acute pancreatitis