Annapaola Dotto

By Annapaola Dotto

Acute pancreatitis is a complex disease, and although most patients have a self-limiting illness, a minority of them develop severe disease and may need Intensive Care Unit admission. Regardless of severity degree, two cornerstones of acute pancreatitis multidisciplinary management are: fluid resuscitation and pain relief. These patients are frequently hypovolemic because of decreased oral intake, vomiting, fever, and fluid sequestration associated with pancreatic and systemic inflammation. Early intravenous volume resuscitation seems to reduce pancreatic hypoperfusion and multiorgan failure, but fluid overload has been associated with worse outcome, and maintaining proper hydration could be challenging. Acute pancreatitis is a very painful condition and effective analgesia is one of the priorities. Pain relief has a positive impact because of reduced stress response, sympathetic-induced vasoconstriction, and pulmonary complications. It is suggested to use a multimodal analgesic approach, to achieve patient’s satisfaction, minimize opioid consumption and side effects. A modern and effective approach involves the use of patient-controlled analgesia and thoracic epidural analgesia. We would revise these two items to offer early and better multidisciplinary management to patients with acute pancreatitis, including those with mild to moderate disease, who are managed in general surgical wards, with the aim to improve their outcome and hospital stay.

Part of the book: Multidisciplinary Management of Acute and Chronic Pancreatitis