THORACIC EPIDURAL ANALGESIA IN A CRITICALLY ILL PATIENT WITH ACUTE PANCREATITIS

Currently, there has been an increase in the incidence of acute pancreatitis worldwide. Despite the improvements in access to care, imaging, and interventional techniques, acute pancreatitis continues to be associated with significant morbidity and mortality. Pain control is an important part of supportive management for patients with acute pancreatitis. A 26-year-old woman presented to our emergency department with a distended abdomen and excruciating pain in the upper abdomen. She was diagnosed with acute pancreatitis. She developed acute respiratory distress; thus, she was intubated and admitted to the intensive care unit. Her upper abdominal pain gradually intensified, causing worsening of acute respiratory distress syndrome. Opioids did not considerably relieve her pain; moreover, their side effects worsened acute pancreatitis. Moreover, thoracic epidural analgesia at the T7-T8 interspace was considered for pain management. After the administration of epidural analgesia, pain substantially improved, abdominal distention markedly reduced, amylase and lipase levels gradually returned to normal, and she was eventually weaned off the ventilator. Epidural analgesia is one of the important pain management modalities, and it stops severe acute pancreatitis development by improving splanchnic and pancreatic perfusion, resulting in decreased liver damage and inflammatory responses.