A systematic review and meta-analysis of Opioids vs Non-Opioids in Acute Pancreatitis

Abstract Background Although abdominal pain is one of the major criteria to diagnose acute pancreatitis (AP) there are no standardized guidelines to treat this troublesome symptom in the hospital setting. Aim To conduct a meta-analysis, to assess the efficacy of non-opioids vs opioids for pain management in AP. Methods We searched the medical literature through May 2021 to identify randomized controlled trials (RCTs) that examined the efficacy of opioids with non-opioids in AP pain management. Efficacy was reported as odds ratio (OR) with 95% confidence intervals (CIs) of each comparison tested. Results We identified 7 eligible RCTs, containing 389 patients. No significant difference in terms of pain intensity at day 1 (OR 0.82, 95% CI -2.55 to 4.19) was found between opioids and non-opioids. Non-opioids has a significantly high risk of supplementary analgesic use compared to opioids (OR 3.87, 95% CI 1.25 to 12.04). However, this significance is not seen when comparing non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol to opioids (OR 1.67, 95% CI 0.73 to 3.82) after excluding trials with Procaine. Opioids did not show a significant increase in the complications of pancreatitis, nausea and vomiting, sedation, and deaths when compared with non-opioids. Conclusions We found non-opioids especially NSAIDs and paracetamol can provide adequate pain relief in patients with AP with no change in supplementary analgesic use and adverse events when compared to opioids. Further research is needed to optimize the use of non-opioids along or in combination with opioids for better pain control in AP patients.