buprenorphine and Pancreatitis

Acute pancreatitis is an acute inflammatory process of the pancreas that may also involve adjacent tissues and/or remote organ systems. Abdominal pain is the main symptom and is usually accompanied by nausea, vomiting and fever. Opoids are commonly used to manage pain in acute pancreatitis but there are still some uncertainties about their clinical effectiveness and safety.. To assess the effectiveness and safety of opioids for treating acute pancreatitis pain.. The search strategy included the Cochrane Upper Gastrointestinal and Pancreatic Diseases Review Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2013, Issue 6), MEDLINE (from 1950 to June 2013) and EMBASE (from 1980 to June 2013). There were no restrictions by language or publication status.. We considered randomised clinical trials (RCTs) assessing the effectiveness of any opioid drug used for treating acute pancreatitis pain.. Two review authors independently selected studies, assessed risks of bias and extracted data. We estimated risk ratios (RRs) for dichotomous data and calculated a 95% confidence interval (CI) for each RR. We performed an intention-to-treat (ITT) analysis. We undertook meta-analysis for some outcomes.. We included five RCTs with a total of 227 participants (age range 23 to 76 years; 65% men) with acute pancreatitis pain. The opioids assessed were intravenous and intramuscular buprenorphine, intramuscular pethidine, intravenous pentazocine, transdermal fentanyl and subcutaneous morphine.One RCT, comparing subcutaneous morphine with intravenous metamizole reported non-significant reduction in the number of participants with improvements in pain intensity (primary outcome) (RR 0.50, 95% CI 0.19 to 1.33). Three studies compared analgesia using opioids with non-opioid treatments. After excluding one study that used opioids through continuous intravenous infusion, there was a decrease in the number of patients requiring supplementary analgesia (RR 0.53, 95% CI 0.30 to 0.93). In a single study, there were no differences in the number of patients requiring supplementary analgesia between buprenorphine and pethidine (RR 0.82, 95% CI 0.61 to 1.10).Pancreatitis complications were not associated with a significant difference between the drugs tested. No clinically serious or life-threatening adverse events occurred related to treatment. No differences for this outcome were found between opioid and non-opioid treatments, or for type of adverse event (nausea-vomiting and somnolence-sedation). One death in the procaine group was reported across all the trials.One RCT comparing pethidine with intramuscular buprenorphine reported non-significant differences of supplementary analgesic, adverse events or deaths. One RCT comparing fentanyl with placebo found no difference in adverse events.The findings of this review are limited by the lack of information to allow full appraisal of the risk of bias, the measurement of relevant outcomes and the small numbers of participants and events covered by the trials.. Opioids may be an appropriate choice in the treatment of acute pancreatitis pain. Compared with other analgesic options, opioids may decrease the need for supplementary analgesia. There is currently no difference in the risk of pancreatitis complications or clinically serious adverse events between opioids and other analgesia options.Future research should focus on the design of trials with larger samples and the measurement of relevant outcomes for decision-making, such as the number of participants showing reductions in pain intensity. The reporting of these RCTs should also be improved to allow users of the medical literature to appraise their results accurately. Large longitudinal studies are also needed to establish the risk of pancreatitis complications and adverse events related to drugs.

Topics: Abdominal Pain; Acute Disease; Analgesics, Opioid; Buprenorphine; Fentanyl; Humans; Meperidine; Morphine; Pancreatitis; Pentazocine; Randomized Controlled Trials as Topic

The following is a summary of the official guidelines of the Italian Association for the Study of the Pancreas regarding the medical, endoscopic and surgical management of acute pancreatitis.. Clinical features together with elevation of the plasma concentrations of pancreatic enzymes are the cornerstones of diagnosis (recommendation A). Contrast-enhanced computed tomography (CT) provides good evidence for the presence of pancreatitis (recommendation C) and it should be carried out 48-72 h after the onset of symptoms in patients with predicted severe pancreatitis. Severity assessment is essential for the selection of the proper initial treatment in the management of acute pancreatitis (recommendation A) and should be done using the APACHE II score, serum C-reactive protein and CT assessment (recommendation C). The etiology of acute pancreatitis should be able to be determined in at least 80% of cases (recommendation B). An adequate volume of intravenous fluid should be administered promptly to correct the volume deficit and maintain basal fluid requirements (recommendation A); analgesia is crucial for the correct treatment of the disease (recommendation A). Enteral feeding is indicated in severe necrotizing pancreatitis and it is better than total parenteral nutrition (recommendation A). The use of prophylactic broad-spectrum antibiotics reduces infection rates in CT-proven necrotizing pancreatitis (recommendation A). Infected pancreatic necrosis in patients with clinical signs and symptoms of sepsis is an indication for intervention, including surgery and radiological drainage (recommendation B).. The participants agreed to revise the guidelines every 3 years in order to re-evaluate each question on the management of acute pancreatitis patients according to the most recent literature.

Topics: Acute Disease; Alanine Transaminase; Analgesics; APACHE; Buprenorphine; Cholecystectomy; Enteral Nutrition; Humans; Lipase; Pancreas; Pancreatitis; Pancreatitis, Acute Necrotizing; Tomography, X-Ray Computed

Acute pancreatitis is a disease with a wide variety of pathophysiologies, ranging from mild to severe condition. In about 80% to 90% of cases, acute pancreatitis presents as a mild inflammation with low morbidity and mortality, self-reversing to normal condition within 3-4 days. However, the natural course of severe pancreatitis progresses into SIRS and necrosis of the pancreas and its surrounding tissue. And infection of the necrotic tissue develops in sepsis and organ failures. Therefore, the initial management for acute pancreatitis would significantly contribute on the early prognosis. The first step includes not only diagnosis but also initial treatment according to etiological assessment and severity stratification. The summarization of initial management revealed as follows: monitorings of temperature, pulse rate, blood pressure, urine output volume, abdominal pain etc, and treatments of cardio-pulmonary care with sufficient fluid resuscitation, pain control, resting of pancreas etc. As the treatment of the initial management after initial onset, the significances of nasogastric tube drainage, prophylactic use of broadspectrum antibiotics, continuous infusion of protease inhibitors, use of H2 receptor antagonists, control by enteral nutrition and so on have been discussed. And also the indications of total parenteral nutrition, selective digestive decontamination and the efficacies of peritoneal lavage, continuous hemodiafiltration and continuous arterial infusion of protease inhibitor and antibiotics have been reviewed. For those events, the evidences were collected by a systemic search of MEDLINE and Japan Centra Revues Medicina. And then practical recommendations were also graded and introduced to provide a framework for clinitians to manage acute pancreatitis as a guideline. This paper described a part of those recommendations.

Topics: Acute Disease; Analgesics, Opioid; Antibiotic Prophylaxis; Biopsy, Fine-Needle; Buprenorphine; Critical Care; Debridement; Diagnosis, Differential; Drainage; Fasting; Fluid Therapy; Gabexate; Histamine H2 Antagonists; Humans; Pancreatitis; Parenteral Nutrition; Patient Transfer; Practice Guidelines as Topic; Serine Proteinase Inhibitors

Acute pancreatitis is commonly associated with severe abdominal pain, making early pain relief a primary goal of the treatment. This study was undertaken to assess the efficacy of a continuous intravenous (i.v.) infusion of procaine compared with that of a placebo infusion in providing pain relief in patients with acute pancreatitis.. 42 patients with acute pancreatitis were prospectively randomized to receive, in a double-blind setting, a continuous i.v. infusion of a 1% solution of procaine (procaine group) or placebo (placebo group, receiving a 0.9% saline solution) on the first three days of treatment in a hospital setting. The maximal infusion rate of the procaine solution was 8 ml/h, i.e. 1.92 g/24 h. The rate and total amount of infused fluid was similar in the placebo group. Additionally buprenorphine (Temgesic, sublingual [s.l.]) were given on demand for additional pain relief.. The gender ratio and the severity of the pancreatitis (APACHE II score, Ranson score) were comparable between the two groups, while the patients of the control group were eight years older (50.1 2.3 vs. 58.4 3.1; p = 0.039). The i.v. infusion of procaine did not reduce the demand for buprenorphine in the procaine group and was similar to that in the placebo group (p=0.88). Furthermore, explorative data analysis revealed that patients of the procaine group had higher bodily discomfort and nausea scores and also tended to feel more pain than the patients of the placebo group.. These data do not indicate a clinically meaningful analgesic effect of i.v. infusion of procaine (maximal amount. 1.92 g/24h) in patients with acute pancreatitis, but suggested that this infusion actually increased the feeling of bodily discomfort and nausea. We thus conclude that a constant i.v. infusion of procaine should no longer be recommended for pain relief in patients with acute pancreatitis anymore.

Topics: Abdominal Pain; Administration, Sublingual; Analgesics, Opioid; Anesthetics, Local; APACHE; Buprenorphine; Double-Blind Method; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Pain Measurement; Pancreatitis; Procaine; Prospective Studies; Treatment Failure

To assess the analgesic efficacy and side effects of buprenorphine and procaine in patients with acute pancreatitis.. Forty patients (average age, 50 years; 23 male) with acute pancreatitis or an acute bout of a chronic pancreatitis were prospectively randomized to receive buprenorphine or procaine for pain relief. Both analgesics were administered as constant intravenous (i.v.) infusions and additional analgesics were given on demand. Pain scores were assessed on a visual analogue scale. Close clinical control and laboratory checks were performed during the three-day study period.. Patients receiving buprenorphine were significantly less likely to demand additional analgesics (1 versus 14 patients; P < 0.0001). The pain scores for patients in the buprenorphine group were significantly lower over the treatment period in comparison to procaine (P < 0.05). The reduction of pain score was significantly greater during the initial two treatment days using buprenorphine (day 1: 55 versus 25, P < 0.0001; day 2: 62 versus 40, P = 0.005). Side effects were comparable for both groups with the exception of a slightly higher sedation rate under buprenorphine.. Constant i.v. application of buprenorphine is more effective than the recommended procaine for pain relief in acute pancreatitis.

Topics: Acute Disease; Adult; Aged; Analgesics; Analgesics, Opioid; Buprenorphine; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Pain; Pain Measurement; Pancreatitis; Procaine; Prospective Studies

The management of intractable pain in chronic pancreatitis is difficult. A novel method for its relief is described.. Twelve patients were given a mixture of buprenorphine (0.3 mg) and blood (10-15 mL) into the epidural space.. All patients had pain relief lasting up to six months.. Epidural buprenorphine injection is a simple, safe and effective method for pain relief in chronic pancreatitis.

Topics: Adolescent; Adult; Analgesics, Opioid; Buprenorphine; Child; Chronic Disease; Female; Humans; Injections, Epidural; Male; Pain Measurement; Pain, Intractable; Pancreatitis; Time Factors; Treatment Outcome

Topics: Acute Disease; Analgesia; Buprenorphine; Humans; Meperidine; Morphinans; Pancreatitis

Mechanisms of pain transduction in acute pancreatitis are poorly understood. Increased Fos expression in the spinal cord is a marker of activation of nociceptive neurons. We hypothesized that cerulein pancreatitis leads to increased Fos expression at T9 and T10, which receive sensory input from the pancreas. Rats were injected with cerulein (100 microg/kg, s.c.) or saline carrier (NS). Endpoints at 4, 6, and 10 h were serum amylase, myeloperoxidase activity (MPO), and spinal cord Fos expression (number of immunoreactive nuclei/section dorsal gray matter). Fos-like immunoreactivity (FLI) at T9-T10 was compared to internal controls (T6, T12). An average of 20 spinal cord histologic sections were evaluated per rat. Some animals were injected with the mu-opioid receptor agonist, buprenorphine (90 microg/kg, s.c.), 3 h after cerulein, and their endpoints were measured at 6 h. Analysis of variance and t tests were used for statistical analysis. Results are means +/- SEM. As expected, cerulein induced edematous pancreatitis, with a 4-fold increase in serum amylase at 6 h [cer (n = 8): 14,000 +/- 1,300 U/ml versus NS (n = 10): 3,700 +/- 300, P < 0.005)] and a 2-fold increase in MPO activity (0.25 +/- 0.05) activity units/dry wt versus 0.13 +/- 0.02, P < 0.05). Cerulein induced nearly a 2-fold increase in FLI at T9 and T10 [n = 10 (cer) and n = 13 (NS): T9, 14 +/- 1.5 versus 7.8 +/- 0.88; T10, 15 +/- 1.7 versus 8.3 +/- 0.70; P < 0.05]. Peak effects of cerulein on FLI occurred at 6 h and were greatest at T9/T10 with relative sparing of T6/T12. T6/T12 expression was similar in experimental and control groups. Buprenorphine significantly reduced both serum amylase and FLI and T9/T10. Cerulein-induced acute pancreatitis in rat increases visceral nociceptive signaling at spinal cord levels T9 and T10, with a peak at 6 h. Blockade of this effect by the mu-opioid receptor agonist buprenorphine could occur either by direct activation of central opioid receptors and/or an anti-inflammatory mechanism. FLI is a useful tool for studying the pathophysiology of pain in experimental acute pancreatitis.

Topics: Animals; Buprenorphine; Ceruletide; Male; Nociceptors; Pancreatitis; Proto-Oncogene Proteins c-fos; Rats; Rats, Sprague-Dawley; Receptors, Opioid, mu; Spinal Cord; Thoracic Vertebrae; Time Factors

Topics: Acute Disease; Adult; Analgesics, Opioid; Buprenorphine; Female; Heroin Dependence; Humans; Pancreatic Function Tests; Pancreatitis; Substance-Related Disorders

Continuous epidural anesthesia was used in a 34 year-old pregnant woman with acute pancreatitis related to hypertriglyceridemia. She underwent an emergency cesarean section due to severe pancreatitis under spinal anesthesia. After delivery, extended incision was made to examine the pancreas and to perform drainage. Epidural infusion using 1% mepivacaine and buprenorphine was started to reduce pain and improve microcirculation. After starting epidural infusion with other therapies, clinical feature and data improved. This case suggests that reduction of severe pain and improvement of microcirculation are important in therapies of severe pancreatitis.

Topics: Acute Disease; Adult; Anesthesia, Epidural; Anesthesia, Obstetrical; Buprenorphine; Cesarean Section; Emergencies; Female; Humans; Mepivacaine; Pancreatitis; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Third

Topics: Analgesics, Opioid; Bile Ducts; Buprenorphine; Chronic Disease; Codeine; Humans; Morphine; Pain; Pancreatitis; Pentazocine; Sphincter of Oddi; Tramadol

Pancreatic enzyme secretion is inhibited during acute pancreatitis, resulting in an increase in acinar zymogen content. Since the premature activation of zymogens has been assigned a central role in the pathogenesis of acute pancreatitis, minimizing the amount of stored zymogens might lead to less severe acute pancreatitis. Inhibition of enzyme synthesis or stimulation of enzyme secretion would result in reduction of zymogen stores. Opiates have a varying effect on pancreatic secretion, depending on the dosage, site of administration, and presence of pancreatic stimulants. The effect of opiates and acute pancreatitis on individual pancreatic enzyme synthesis is unknown. The following study was undertaken in order to examine the effects of an opiate on pancreatic enzyme secretion and synthesis during experimental acute pancreatitis. Four groups of rats were studied. Group I received cerulein (25 micrograms/kg); group II received an opiate, buprenorphine (BPN, 0.5 mg/kg); and group III received cerulein and BPN. Drugs were dissolved in gelatin/saline and injected subcutaneously. A control group (group IV) received only gelatin/saline. Rats were sacrificed 4 hr after injection, and pancreatic mass was measured. Pancreatic acini were prepared and assayed for amylase and DNA content. Amylase, trypsinogen, chymotrypsinogen and lipase synthesis, and amylase secretion were measured for 2 hr. Results showed that, compared to controls, acini of rats with AP had increased amylase content, a finding consistent with decreased in vivo amylase secretion. Total protein and individual enzyme synthesis rates were significantly lower in the acini of the rats with AP than in those of the controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Amylases; Animals; Buprenorphine; Ceruletide; Chymotrypsinogen; Edema; Lipase; Male; Pancreas; Pancreatitis; Rats; Rats, Inbred Strains; Trypsinogen

Buprenorphine (15 micrograms/kg b.wt. per hour) distinctly reduced pain sensitivity in acute 3% sodium-taurocholate pancreatitis in male Wistar rats without interfering with the course of the disease. This was seen by assessment of enzyme elevation in serum and ascites and by histological evaluation of the pancreas. Buprenorphine is therefore recommended for animal experiments to study the effect of therapeutic principles in acute pancreatitis.

Topics: Acute Disease; Animals; Buprenorphine; Male; Pain; Pancreatitis; Rats; Rats, Inbred Strains; Taurocholic Acid

Topics: Adult; Antidepressive Agents; Buprenorphine; Chronic Disease; Humans; Male; Middle Aged; Morphine; Pain; Pancreatitis; Pyridoxine; Thiamine