A systematic review and meta-analysis depicted that for the management of acute pancreatitis, non-steroidal anti-inflammatory drugs (NSAIDs) are an effective opiate sparing alternative while epidural administration seems to be effective during the initial 24 hours. With the aim to explore the optimal analgesic approach for individuals having acute pancreatitis, this study determined the effectiveness of different analgesic modalities for acute pancreatitis management.

For identifying relevant randomized controlled trials investigating analgesic modalities for acute pancreatitis, databases like Web of Science, PubMed, SCOPUS, EMBASE, CENTRAL, and MEDLINE were searched. Researchers carried out a pooled assessment of improvement in visual analogue scale (VAS) pain scores on days 0, 1 and 2. A total of 12 RCTs were found including 542 participants.

Overall, 7 trial drugs were evaluated: paracetamol, opiates, epidural, NSAIDs, metamizole, placebo, and local anaesthetic. Across all the modalities, the pooled pain scores demonstrated a global improvement from the baseline to day 2. Epidural analgesia seems to offer the highest improvement in VAS pain scores within the initial 24 hours but is equivalent to opiates by 48 hours. Within 24 hours, non-steroidal anti-inflammatory agents provided comparable pain mitigation when compared to opiates, while placebo also displayed equivalence when compared to other modalities but then plateaued.

Local anesthetics illustrated the least overall effectiveness. For non-opiate and opiate analgesics, the pain scores were noted to be similar at day 1 and baseline. The RCTs showed considerable statistical and methodological heterogeneity in reporting pain alleviation. A considerable paucity of level 1 evidence for guiding pain management in acute pancreatitis with small datasets per study was noted.

Epidural administration seems to be efficacious within initial 24 hours of acute pancreatitis (though infrequently utilized and featured in only single randomized controlled trial). During the initial 24 hours, NSAIDs are an efficacious opiate sparing substitute.