Analgesia epidural torácica: para el manejo de pancreatitis aguda.

Abstract

Acute pancreatitis is one of the most frequent gastrointestinal diseases that cause hospitalization, it is linked to various causes where the most common is represented by gallstones and excessive alcohol consumption. Clinically it manifests itself with pain at the epigastric level that is usually constant and radiates to the back, its diagnosis is usually with two or more criteria which refer to the typical symptoms, high levels of amylase and lipase, and an imaging study. Current treatment for acute pancreatitis is symptomatic apart from removal of gallstones if warranted. Symptomatic measures are based on aggressive rehydration, early nutrition, analgesia, oxygenation and restricting the use of antibiotics, they should only be used when infection is confirmed.

These measures do not directly influence the pancreas, but are based on reducing the process of the multi-organ inflammatory response syndrome, which is what usually develops in severe pancreatitis. The use of thoracic epidural analgesia has been described during the development of this disease, especially in animal and human studies. The hypothesis is based on the fact that selective segmental sympathectomy achieved with thoracic epidural analgesia improves splanchnic perfusion, generating changes in microcirculation, improving blood flow to the pancreas. At present, more research should be done on the benefits beyond analgesia in acute pancreatitis with an analysis of its risks, the various studies to date indicate the safety of applying this technique.