Manejo de la analgesia en la pancreatitis aguda. Resultados de una encuesta nacional / Management of analgesia in acute pancreatitis: Results of a national survey

Introducción La pancreatitis aguda constituye uno de los principales motivos de ingreso por causa digestiva. En su manejo resulta crucial un adecuado tratamiento del dolor. Pero apenas existen descripciones sobre las pautas analgésicas empleadas en nuestro medio. Métodos Encuesta on-line sobre el manejo de analgésicos en la pancreatitis aguda, dirigida a médicos adjuntos y residentes con ejercicio en España. Resultados Un total de 209 facultativos de 88 centros respondieron la encuesta. El 90% eran especialistas en Aparato Digestivo y el 69% trabajaba en un centro terciario. La mayoría (64,4%) no utilizan habitualmente escalas para medir el dolor. Al elegir un fármaco se valora sobre todo la experiencia en su uso. Los tratamientos más prescritos inicialmente son: combinación de paracetamol y metamizol (53,5%), paracetamol solo (19,1%) y metamizol solo (17,4%). Como rescate: meperidina (54,8%), tramadol (17,8%), cloruro mórfico (17,8%) y metamizol (11,5%). Se utiliza perfusión continua en el 8,2% de los tratamientos iniciales. Los médicos con >10años de servicio utilizan más metamizol en monoterapia (50%), mientras que médicos residentes y adjuntos con <10años de servicio lo prescriben asociado a paracetamol (85%). Si se necesita progresar, se usan fundamentalmente cloruro mórfico y meperidina. La especialidad del encuestado, el tamaño del centro de trabajo y la unidad/servicio donde ingresaban los pacientes no influyeron sobre la analgesia pautada. El grado de satisfacción con el tratamiento del dolor alcanzó el 7,8/10 (DE 0,98). Conclusión En nuestro medio, el metamizol y el paracetamol son los analgésicos más empleados como tratamiento inicial del dolor en la pancreatitis aguda, y la meperidina, el analgésico de rescate más utilizado (AU)

Introduction Acute pancreatitis is one of the main reasons for digestive admissions. Adequate pain treatment is crucial in its management. However, there are hardly any descriptions of the analgesic guidelines used in our setting. Methods On-line survey on analgesic management in acute pancreatitis, aimed at attending physicians and residents practising in Spain. Results Two hundred and nine physicians from 88 centres responded to the survey. Ninety percent were specialists in gastrointestinal medicine and 69% worked in a tertiary centre. The majority (64.4%) do not routinely use scales to measure pain. When choosing a drug, experience in its use was the most important factor. The most commonly prescribed initial treatments are: combination of paracetamol and metamizole (53.5%), paracetamol alone (19.1%) and metamizole alone (17.4%). As rescue: meperidine (54.8%), tramadol (17.8%), morphine chloride (17.8%) and metamizole (11.5%). Continuous perfusion is used in 8.2% of initial treatments. Physicians with >10 years of service use more metamizole as monotherapy (50%), while residents and attending physicians with <10 years of service prescribe it in combination with paracetamol (85%). If progression is needed, morphine chloride and meperidine are mainly used. The speciality of the respondent, the size of the work centre and the unit/service where the patients were admitted did not influence the analgesia prescribed. Satisfaction with pain management reached 7.8/10 (SD 0.98). Conclusion In our setting, metamizole and paracetamol are the most commonly used analgesics as initial pain treatment in acute pancreatitis, and meperidine is the most commonly used rescue analgesic. (AU)

Management of analgesia in acute pancreatitis: Results of a national survey. / Manejo de la analgesia en la pancreatitis aguda. Resultados de una encuesta nacional.

INTRODUCTION: Acute pancreatitis is one of the main reasons for digestive admissions. Adequate pain treatment is crucial in its management. However, there are hardly any descriptions of the analgesic guidelines used in our setting. METHODS: On-line survey on analgesic management in acute pancreatitis, aimed at attending physicians and residents practising in Spain. RESULTS: Two hundred and nine physicians from 88 centres responded to the survey. Ninety percent were specialists in gastrointestinal medicine and 69% worked in a tertiary centre. The majority (64.4%) do not routinely use scales to measure pain. When choosing a drug, experience in its use was the most important factor. The most commonly prescribed initial treatments are: combination of paracetamol and metamizole (53.5%), paracetamol alone (19.1%) and metamizole alone (17.4%). As rescue: meperidine (54.8%), tramadol (17.8%), morphine chloride (17.8%) and metamizole (11.5%). Continuous perfusion is used in 8.2% of initial treatments. Physicians with >10 years of service use more metamizole as monotherapy (50%), while residents and attending physicians with <10 years of service prescribe it in combination with paracetamol (85%). If progression is needed, morphine chloride and meperidine are mainly used. The speciality of the respondent, the size of the work centre and the unit/service where the patients were admitted did not influence the analgesia prescribed. Satisfaction with pain management reached 7.8/10 (SD 0.98). CONCLUSION: In our setting, metamizole and paracetamol are the most commonly used analgesics as initial pain treatment in acute pancreatitis, and meperidine is the most commonly used rescue analgesic.

[High incidence rates of inflammatory bowel disease in Navarra (Spain). Results of a prospective, population-based study]. / Altas tasas de incidencia de enfermedad inflamatoria intestinal en Navarra. Resultados de un estudio prospectivo y poblacional.

INTRODUCTION: As reflected in the European Collaborative Study on Inflammatory Bowel Disease (1991-1993), differences between northern and southern European countries in the incidence of ulcerative colitis (UC) and Crohn's disease (CD) show a tendency to decrease. No data are available on the current incidence of these diseases in Navarre (northern Spain). AIM: To determine the present incidence of inflammatory bowel disease (IBD) in Navarra. PATIENTS AND METHODS: A prospective, population-based study was performed to determine the incidence of IBD in Navarra between 2001 and 2003. Total population: 569,628 inhabitants (284,620 males). All cases of IBD diagnosed in any public or private hospital in Navarre were included in the study. Crude rates and age- and sex-specific rates adjusted to the European standard population were calculated. RESULTS: A total of 288 cases were diagnosed (UC 176, CD 102, indeterminate colitis 10). Crude rates of UC, CD and indeterminate colitis were 10.29, 5.96 and 0.58 cases/100,000 inhabitants/year respectively (the population aged 0-14 years of age was included). Specific rates were 9.57 (95% CI, 7.27-12.57) and 5.85 (95% CI, 3.99-8.14) cases/100,000 inhabitants/year for UC and CD, respectively. CONCLUSIONS: The incidence of UC and CD in Navarra has increased in the last decade, with rates close to those of northern European countries and higher than those recently published in Spanish prospective studies.

Altas tasas de incidencia de enfermedad inflamatoria intestinal en Navarra. Resultados de un estudio prospectivo y poblacional / High incidence rates of inflammatory bowel disese in Navarra (Spain). Results of a prospective, population-based study

INTRODUCCIÓN: Tal como se reflejó en el Estudio CooperativoEuropeo del período 1991-1993, tienden a reducirse lasdiferencias norte/sur en las tasas de incidencia de colitis ulcerosa(CU) y enfermedad de Crohn (EC). No hay estudiosque hayan actualizado el estado de la cuestión en Navarra.OBJETIVOS: Nos planteamos conocer la incidencia actual dela enfermedad inflamatoria intestinal (EII) en Navarra.PACIENTES Y MÉTODOS: Estudio prospectivo y poblacional dela incidencia de EII en Navarra en el período 2001-2003, enuna población de 569.628 habitantes (284.620 varones). Serecogen la totalidad de los casos diagnosticados en todos loscentros públicos y privados de Navarra con capacidad dediagnosticar una EII. Se calculan las tasas crudas y las tasasespecíficas ajustadas a la población estándar europea.RESULTADOS: Se diagnosticaron 288 casos (176 CU, 102 EC y10 colitis indeterminadas [CI]). Las tasas crudas para CU,EC y CI fueron de 10,29, 5,96 y 0,58 casos/100.000 habitantes/año, respectivamente (incluida la población de 0-14 añosde edad). Las tasas específicas (intervalo de confianza del95%) fueron de 9,57 (7,27-12,57) y 5,85 (3,99-8,14) casos/100.000 habitantes/año para CU y EC, respectivamente.CONCLUSIONES: La incidencia de CU y EC en Navarra haaumentado en la última década, con tasas cercanas a las referidasen los países del norte de Europa y algo superiores alas de los últimos estudios prospectivos españoles

INTRODUCTION: As reflected in the European Collaborative Study on Inflammatory Bowel Disease (1991-1993), differencesbetween northern and southern European countries in theincidence of ulcerative colitis (UC) and Crohn’s disease (CD)show a tendency to decrease. No data are available on the currentincidence of these diseases in Navarre (northern Spain).AIM: To determine the present incidence of inflammatorybowel disease (IBD) in Navarra.PATIENTS AND METHODS: A prospective, population-basedstudy was performed to determine the incidence of IBD inNavarra between 2001 and 2003. Total population: 569,628inhabitants (284,620 males). All cases of IBD diagnosed inany public or private hospital in Navarre were included inthe study. Crude rates and age- and sex-specific rates adjustedto the European standard population were calculated.RESULTS: A total of 288 cases were diagnosed (UC 176, CD102, indeterminate colitis 10). Crude rates of UC, CD andindeterminate colitis were 10.29, 5.96 and 0.58 cases/100,000inhabitants/year respectively (the population aged 0-14 yearsof age was included). Specific rates were 9.57 (95% CI,7.27-12.57) and 5.85 (95% CI, 3.99-8.14) cases/100,000 inhabitants/year for UC and CD, respectively.CONCLUSIONS: The incidence of UC and CD in Navarra hasincreased in the last decade, with rates close to those of northernEuropean countries and higher than those recently published in Spanish prospective studies (AU)