RESUMEN
BACKGROUND: This systematic review explored the efficacy of different analgesic modalities and the impact on perioperative outcome in patients undergoing pancreatoduodenectomy. METHODS: A systematic literature search was performed on PubMed, Embase, Web of Science, Scopus, and Cochrane Library Database using the PRISMA framework. The primary outcome was pain scores on postoperative day one (POD1) and postoperative day two (POD2). The secondary outcomes included length of hospital stay (LOS) and specific procedure-related complications. RESULTS: Five randomized controlled trials and ten retrospective cohort studies were included in the systematic review. Studies compared epidural analgesia (EA), patient-controlled analgesia (PCA), continuous wound infiltration (CWI), continuous bilateral thoracic paravertebral infusion (CTPVI), intrathecal morphine (ITM), and sublingual sufentanil. The pain scores on POD1 (p < 0.001) and POD2 (p = 0.05) were higher in the PCA group compared with the EA group. Pain scores were comparable between EA and CWI plus PCA or CTPVI on POD1 and POD2. Pain scores were comparable between EA and ITM on POD1. The procedure-related complications and length of hospital stay were not significantly different according to the type of analgesia. CONCLUSIONS: EA provided lower pain scores compared with PCA on the first postoperative day after pancreatoduodenectomy; the length of hospital stay and procedure-related complications were similar between EA and PCA. CWI and CTPVI provided similar pain relief to EA.
RESUMEN
Beside the common situations of upper gastrointestinal bleeding (GIB) managed by endoscopy, there are clinical situations when the endoscopic approach is limited by the amount of blood, the hemodynamic instability, the intermittent nature of bleeding and a proper diagnosis and treatment requires radiological interventional methods and even surgery. The pancreatic pathology is rarely considered as a possible cause for patients that presents in emergencies with GIB. The rupture of visceral artery aneurysms (VAAs), without underlying pancreatic pathology, should also be regarded in the differential diagnosis of GIB. Even the natural history of VAAs is not well understood, there is a potential risk of bleeding in the gastrointestinal tract, peritoneal cavity and retroperitoneal space, that can result in death. In this paper, we aim to review the rare causes of GIB focusing on pancreatic pathology and VAAs, unrevealed by the underlying pathology and presenting in the emergency department with bleeding symptoms and signs.
