Department of Gastroenterology & Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
United European Gastroenterol J. 2024 Oct;12(8):1114-1127. doi: 10.1002/ueg2.12641. Epub 2024 Aug 14.
Since there is no current international consensus on the optimal approach for pain management in acute pancreatitis (AP), analgesic practices may vary across different healthcare settings.
This study explored global disparities in analgesic use, in particular opioids, during admission and at discharge in hospitalised AP patients.
This was a post hoc analysis of the prospective PAINAP database, which included all admissions for AP between April and June 2022 with a 1-month follow-up. Demographic details, analgesic use, and clinical outcomes were recorded during admission and at discharge. Odds ratios (ORs) for opioid use during admission and at discharge were identified using multivariable regression analyses.
Amongst the 1864 patients (52% males, median age 56 (interquartile range, 41-71)) across three different continents, simple analgesics were predominantly used as the primary analgesic (70%). Opioid use during admission was lowest in European centres (67%). Admission in Asian (OR, 2.53 (95% confidence interval (CI), 1.59-4.04), p < 0.001), and Australian (OR, 5.81 (95% CI, 3.19-10.56), p < 0.001) centres was associated with opioid administration during admission compared with European centres. Increased pain severity, longer pre-admission pain duration, organ failure, and longer length of admission increased opioid use during admission. At discharge, Asian (OR, 2.01 (95% CI, 1.40-2.88), p < 0.001) and Australian (OR, 1.91 (95% CI, 1.28-2.85), p = 0.002) centres were associated with opioid prescription compared with European centres. Increased pain severity, longer pre-admission pain duration, acute necrotic collections, and walled-off necrosis also increased the likelihood of opioid prescription at discharge.
There are substantial intercontinental differences in opioid use for AP pain. Accordingly, there is a need for international guidelines on pain management in AP.
目前对于急性胰腺炎（AP）的疼痛管理，国际上尚无统一的最佳方法，因此在不同的医疗保健环境中，镇痛方法可能存在差异。
本研究旨在探讨全球范围内在住院 AP 患者的入院和出院时，阿片类药物等镇痛药物使用的差异。
这是对前瞻性 PAINAP 数据库的事后分析，该数据库纳入了 2022 年 4 月至 6 月期间所有因 AP 入院并进行 1 个月随访的患者。记录了患者入院和出院时的人口统计学资料、镇痛药物使用情况和临床结局。使用多变量回归分析确定入院和出院时使用阿片类药物的比值比（OR）。
在来自三个不同大陆的 1864 名患者（52%为男性，中位年龄 56 岁（四分位距，41-71））中，主要使用非甾体类抗炎药作为一线镇痛药物（70%）。欧洲中心的入院时阿片类药物使用率最低（67%）。与欧洲中心相比，亚洲（OR，2.53（95%置信区间（CI），1.59-4.04），p<0.001）和澳大利亚（OR，5.81（95% CI，3.19-10.56），p<0.001）中心的入院与阿片类药物的使用相关。疼痛严重程度增加、入院前疼痛持续时间延长、器官功能衰竭和住院时间延长与入院时阿片类药物的使用增加相关。出院时，与欧洲中心相比，亚洲（OR，2.01（95% CI，1.40-2.88），p<0.001）和澳大利亚（OR，1.91（95% CI，1.28-2.85），p=0.002）中心更可能开具阿片类药物处方。疼痛严重程度增加、入院前疼痛持续时间延长、急性坏死性积聚和包裹性坏死也增加了出院时开具阿片类药物的可能性。
AP 疼痛的阿片类药物使用在洲际间存在显著差异。因此，需要制定 AP 疼痛管理的国际指南。
