RESUMO
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.
Assuntos
Analgesia , Pancreatite , Humanos , Manejo da Dor , Acetaminofen/uso terapêutico , Dipirona/uso terapêutico , Morfina , Doença Aguda , Pancreatite/tratamento farmacológico , Dor , Meperidina/uso terapêutico , Analgésicos/uso terapêuticoAssuntos
Infecções por HIV/complicações , Hipertensão Portal/etiologia , Veias Mesentéricas , Veia Porta , Trombose Venosa/complicações , Adulto , Anemia/etiologia , Biópsia , Transfusão de Eritrócitos , Varizes Esofágicas e Gástricas/etiologia , Humanos , Fígado/patologia , Masculino , Melena/etiologiaRESUMO
Pancreaticopleural fistula is a rare complication of acute or chronic pancreatitis, requiring medical (somatostatin), endoscopic or surgical treatment, with medical treatment being the first option. We describe the case of a 64-year-old man who showed complete disruption of Wirsung's duct that was diagnosed through ultrasound endoscopy and was complicated by the development of a subphrenic collection, diaphragm perforation and subsequent empyema. Medical therapy was attempted without success, and anatomical restoration of the duct was achieved after endoscopic treatment. The patient also required surgery to evacuate the pleural collection.
Assuntos
Fístula Pancreática/complicações , Pancreatite/complicações , Derrame Pleural/etiologia , Fístula do Sistema Respiratório/complicações , Doença Aguda , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Pleurais/complicaçõesRESUMO
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Assuntos
Humanos , Masculino , Adulto , Veia Porta/fisiopatologia , Hipertensão Portal/complicações , Trombose Venosa/etiologia , Infecções por HIV/complicações , Melena/etiologiaRESUMO
La fístula pancreaticopleral es una rara complicación de la pancreatitis aguda o crónica, que requiere de tratamiento médico (análogos de somatostatina), endoscópico o quirúrgico para su resolución, siendo el primero de estos de elección. Presentamos el caso de un varón de 64 años que presenta disrupción completa del conducto de Wirsung, diagnosticada mediante ecoendoscopia y complicada con colección subfrénica, perforación diafragmática y posterior empiema. En este caso se ensayó sin éxito tratamiento médico y posteriormente endoscópico, que permitió finalmente la resolución de la lesión anatómica. El paciente precisó además una intervención quirúrgica para conseguir la evacuación de la colección pleural (AU)
Pancreaticopleural fistula is a rare complication of acute or chronic pancreatitis, requiring medical (somatostatin), endoscopic or surgical treatment, with medical treatment being the first option. We describe the case of a 64-year-old man who showed complete disruption of Wirsung's duct that was diagnosed through ultrasound endoscopy and was complicated by the development of a subphrenic collection, diaphragm perforation and subsequent empyema. Medical therapy was attempted without success, and anatomical restoration of the duct was achieved after endoscopic treatment. The patient also required surgery to evacuate the pleural collection (AU)