Manejo Farmacológico del Dolor en Pancreatitis Aguda en Pacientes Adultos
Resumen
La pancreatitis aguda (PA) una amplia variedad de cursos clínicos. El síntoma que más predomina es el dolor abdominal(de-Madaria et al., 2021); es una prioridad el tratamiento del dolor en la PA, sin embargo, la evidencia científica actual es poco clara, encontrando déficit en cuanto a la descripción concisa sobre un protocolo analgésico eficaz. Este trabajo tiene como objetivo realizar una revisión detallada de las terapias farmacológicas actuales descritas en la evidencia científica para el tratamiento de la PA en adultos, basándonos en diversas plataformas científicas y bases de datos especializadas internacionales y nacionales en idioma español e inglés, incluyendo alrededor de 32 artículos actualizados que brindan esta información pertinente. Se observó que el manejo del dolor en la PA es una prioridad, que se debe personalizar el tratamiento con base en la escala analgésica de la Organización Mundial de la Salud (OMS) que incluye los Antiinflamatorios no esteroideos (AINES), paracetamol, opiáceos fuertes o débiles tomando en cuenta los comórbidos, tolerabilidad e intensidad del dolor presente en el paciente; por otra parte la nueva terapia basada en analgesia epidural muestra ser bastante prometedora, sin embargo, consideramos que aún se requieren investigaciones científicas con cohortes más grandes.
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Akter, N., Ratnayake, B., Joh, D. B., Chan, S.-J., Bonner, E., & Pandanaboyana, S. (2021). Postoperative Pain Relief after Pancreatic Resection: Systematic Review and Meta-Analysis of Analgesic Modalities. World Journal of Surgery, 45(10), 3165–3173. https://doi.org/10.1007/s00268-021-06217-x
Al-Leswas, D., Baxter, N., Lim, W. B., Robertson, F., Ratnayake, B., Samanta, J., Capurso, G., de-Madaria, E., Drewes, A. M., Windsor, J., & Pandanaboyana, S. (2023). The safety and efficacy of epidural anaesthesia in acute pancreatitis: a systematic review and meta-analysis. HPB, 25(2), 162–171. https://doi.org/10.1016/j.hpb.2022.12.004
Bainbridge, D., Martin, J. E., & Cheng, D. C. (2006). Patient-controlledversus nurse-controlled analgesia after cardiac surgery — a meta-analysis. Canadian Journal of Anesthesia/Journal Canadien d’anesthésie, 53(5), 492–499. https://doi.org/10.1007/BF03022623
Basurto Ona, X., Rigau Comas, D., & Urrútia, G. (2013). Opioids for acute pancreatitis pain. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD009179.pub2
Cai, W., Liu, F., Wen, Y., Han, C., Prasad, M., Xia, Q., Singh, V. K., Sutton, R., & Huang, W. (2021a). Pain Management in Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Frontiers in Medicine, 8.
https://doi.org/10.3389/fmed.2021.782151
Cai, W., Liu, F., Wen, Y., Han, C., Prasad, M., Xia, Q., Singh, V. K., Sutton, R., & Huang, W. (2021b). Pain Management in Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Frontiers in Medicine, 8.
https://doi.org/10.3389/fmed.2021.782151
Cai, W., Liu, F., Wen, Y., Han, C., Prasad, M., Xia, Q., Singh, V. K., Sutton, R., & Huang, W. (2021c). Pain Management in Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Frontiers in Medicine, 8.
https://doi.org/10.3389/fmed.2021.782151
de-Madaria, E., Sánchez-Marin, C., Carrillo, I., Vege, S. S., Chooklin, S., Bilyak, A., Mejuto, R., Mauriz, V., Hegyi, P., Márta, K., Kamal, A., Lauret-Braña, E., Barbu, S. T., Nunes, V., Ruiz-Rebollo, M. L., García-Rayado, G., Lozada-Hernandez, E. E., Pereira, J., Negoi, I., … Mira, J. J. (2021). Design and validation of a patient-reported outcome measure scale in acute pancreatitis: the PAN-PROMISE study. Gut, 70(1), 139–147. https://doi.org/10.1136/gutjnl-2020-320729
Dooley, N., Hew, S., & Nichol, A. (2015). Acute pancreatitis: an intensive care perspective. Anaesthesia & Intensive Care Medicine, 16(4), 191–196. https://doi.org/10.1016/j.mpaic.2015.01.017
Garber, A., Frakes, C., Arora, Z., & Chahal, P. (2018). Mechanisms and Management of Acute Pancreatitis. Gastroenterology Research and Practice, 2018, 1–8.
https://doi.org/10.1155/2018/6218798
Huang, Z., Ma, X., Jia, X., Wang, R., Liu, L., Zhang, M., Wan, X., Tang, C., & Huang, L. (2020). Prevention of Severe Acute Pancreatitis With Cyclooxygenase-2 Inhibitors: A Randomized Controlled Clinical Trial. American Journal of Gastroenterology, 115(3), 473–480. https://doi.org/10.14309/ajg.0000000000000529
Jabaudon, M., Belhadj-Tahar, N., Rimmelé, T., Joannes-Boyau, O., Bulyez, S., Lefrant, J.-Y., Malledant, Y., Leone, M., Abback, P.-S., Tamion, F., Dupont, H., Lortat-Jacob, B., Guerci, P., Kerforne, T., Cinotti, R., Jacob, L., Verdier, P., Dugernier, T., Pereira, B., & Constantin, J.-M. (2018). Thoracic Epidural Analgesia and Mortality in Acute Pancreatitis: A Multicenter Propensity Analysis. Critical Care Medicine, 46(3), e198–e205.
https://doi.org/10.1097/CCM.0000000000002874
Lankisch, P. G., Apte, M., & Banks, P. A. (2015). Acute pancreatitis. The Lancet, 386(9988), 85–96. https://doi.org/10.1016/S0140-6736(14)60649-8
Machicado, J. D., & Papachristou, G. I. (2019). Pharmacologic management and prevention of acute pancreatitis. Current Opinion in Gastroenterology, 35(5), 460–467.
https://doi.org/10.1097/MOG.0000000000000563
Manrai, M., Dawra, S., Singh, A. K., Jha, D. K., & Kochhar, R. (2023). Controversies in the management of acute pancreatitis: An update. World Journal of Clinical Cases, 11(12), 2582–2603. https://doi.org/10.12998/wjcc.v11.i12.2582
Mäntyselkä, P., Kumpusalo, E., Ahonen, R., Kumpusalo, A., Kauhanen, J., Viinamäki, H., Halonen, P., & Takala, J. (2001). Pain as a reason to visit the doctor: a study in Finnish primary health care. Pain, 89(2), 175–180. https://doi.org/10.1016/S0304-3959(00)00361-4
Meng, W., Yuan, J., Zhang, C., Bai, Z., Zhou, W., Yan, J., & Li, X. (2013). Parenteral analgesics for pain relief in acute pancreatitis: A systematic review. Pancreatology, 13(3), 201–206. https://doi.org/10.1016/j.pan.2013.02.003
Peery, A. F., Dellon, E. S., Lund, J., Crockett, S. D., McGowan, C. E., Bulsiewicz, W. J., Gangarosa, L. M., Thiny, M. T., Stizenberg, K., Morgan, D. R., Ringel, Y., Kim, H. P., DiBonaventura, M. D., Carroll, C. F., Allen, J. K., Cook, S. F., Sandler, R. S., Kappelman, M. D., & Shaheen, N. J. (2012). Burden of Gastrointestinal Disease in the United States: 2012 Update. Gastroenterology, 143(5), 1179-1187.e3. https://doi.org/10.1053/j.gastro.2012.08.002
Peiró, A. M., Martínez, J., Martinez, E., Madaria, E. de, Llorens, P., Horga, J. F., & Pérez-Mateo, M. (2008). Efficacy and Tolerance of Metamizole versus Morphine for Acute Pancreatitis Pain. Pancreatology, 8(1), 25–29. https://doi.org/10.1159/000114852
Perera, M., Tattersall, M., & Wysocki, A. (2014). Analgesia in Patients with Acute Pancreatitis: A Cry for Help. International Journal of Gastroenterology Research and Practice, 1–10. https://doi.org/10.5171/2014.343907
Phillip, V., Schuster, T., Hagemes, F., Lorenz, S., Matheis, U., Preinfalk, S., Lippl, F., Saugel, B., Schmid, R. M., & Huber, W. (2013). Time Period From Onset of Pain to Hospital Admission and Patients’ Awareness in Acute Pancreatitis. Pancreas, 42(4), 647–654. https://doi.org/10.1097/MPA.0b013e3182714565
Rodgers, A. (2000). Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised. BMJ, 321(7275), 1493–1493. https://doi.org/10.1136/bmj.321.7275.1493
Sadowski, S. M. (2015). Epidural anesthesia improves pancreatic perfusion and decreases the severity of acute pancreatitis. World Journal of Gastroenterology, 21(43), 12448. https://doi.org/10.3748/wjg.v21.i43.12448
Singh, V. K., Whitcomb, D. C., Banks, P. A., AlKaade, S., Anderson, M. A., Amann, S. T., Brand, R. E., Conwell, D. L., Cote, G. A., Gardner, T. B., Gelrud, A., Guda, N., Forsmark, C. E., Lewis, M., Sherman, S., Muniraj, T., Romagnuolo, J., Tan, X., Tang, G., … Steinberg, W. (2022). Acute pancreatitis precedes chronic pancreatitis in the majority of patients: Results from the NAPS2 consortium. Pancreatology, 22(8), 1091–1098. https://doi.org/10.1016/j.pan.2022.10.004
Sotoudehmanesh, R., Khatibian, M., Kolahdoozan, S., Ainechi, S., Malboosbaf, R., & Nouraie, M. (2007). Indomethacin May Reduce the Incidence and Severity of Acute Pancreatitis After ERCP. The American Journal of Gastroenterology, 102(5), 978–983. https://doi.org/10.1111/j.1572-0241.2007.01165.x
Sternby, H., Bolado, F., Canaval-Zuleta, H. J., Marra-López, C., Hernando-Alonso, A. I., del-Val-Antoñana, A., García-Rayado, G., Rivera-Irigoin, R., Grau-García, F. J., Oms, L., Millastre-Bocos, J., Pascual-Moreno, I., Martínez-Ares, D., Rodríguez-Oballe, J. A., López-Serrano, A., Ruiz-Rebollo, M. L., Viejo-Almanzor, A., González-de-la-Higuera, B., Orive-Calzada, A., … de-Madaria, E. (2019). Determinants of Severity in Acute Pancreatitis. Annals of Surgery, 270(2), 348–355. https://doi.org/10.1097/SLA.0000000000002766
Takada, T., Isaji, S., Mayumi, T., Yoshida, M., Takeyama, Y., Itoi, T., Sano, K., Iizawa, Y., Masamune, A., Hirota, M., Okamoto, K., Inoue, D., Kitamura, N., Mori, Y., Mukai, S., Kiriyama, S., Shirai, K., Tsuchiya, A., Higuchi, R., & Hirashita, T. (2022). JPN clinical practice guidelines 2021 with easy‐to‐understand explanations for the management of acute pancreatitis. Journal of Hepato-Biliary-Pancreatic Sciences, 29(10), 1057–1083. https://doi.org/10.1002/jhbp.1146
Tenner, S., Baillie, J., DeWitt, J., & Vege, S. S. (2013). American College of Gastroenterology Guideline: Management of Acute Pancreatitis. American Journal of Gastroenterology, 108(9), 1400–1415. https://doi.org/10.1038/ajg.2013.218
Thavanesan, N., White, S., Lee, S., Ratnayake, B., Oppong, K. W., Nayar, M. K., Sharp, L., Drewes, A. M., Capurso, G., De-Madaria, E., Siriwardena, A. K., Windsor, J. A., & Pandanaboyana, S. (2022). Analgesia in the Initial Management of Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. World Journal of Surgery, 46(4), 878–890. https://doi.org/10.1007/s00268-021-06420-w
Thompson, D. R. (2001). Narcotic Analgesic Effects on The Sphincter of Oddi: A Review of The Data and Therapeutic Implications in Treating Pancreatitis. American Journal of Gastroenterology, 96(4), 1266–1272. https://doi.org/10.1111/j.1572-0241.2001.03536.x
van Dijk, S. M., Hallensleben, N. D. L., van Santvoort, H. C., Fockens, P., van Goor, H., Bruno, M. J., & Besselink, M. G. (2017). Acute pancreatitis: recent advances through randomised trials. Gut, 66(11), 2024–2032. https://doi.org/10.1136/gutjnl-2016-313595
Windisch, O., Heidegger, C.-P., Giraud, R., Morel, P., & Bühler, L. (2016). Thoracic epidural analgesia: a new approach for the treatment of acute pancreatitis? Critical Care, 20(1), 116. https://doi.org/10.1186/s13054-016-1292-7
Derechos de autor 2023 Carlos Eduardo Fuentes Baez , Moisés Santiago González, Leticia Sánchez Villarreal, Karla Miroslava Escobar Moreno
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
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