This systematic review and meta-analysis put forwards valuable insights on the analgesic use for pain management in patients with acute pancreatitis. The use of epidural anesthesia was recognized as the most effective analgesic when used within the first 24 hours.

This review aimed to examine the efficacy of different analgesics used in acute pancreatitis.

Database search included exploring PubMed, MEDLINE and EMBASE until June 2021 to recognize all randomized control trials (RCTs) about the comparison of analgesic modalities used in acute pancreatitis. Pain relief as assessed by the visual analogue scale (VAS) on the same day, day 1 and day 2 was regarded as the primary outcome.

Overall, 12 RCTs were recognized comprising of 542 patients. A comparison of opiates, non-steroidal anti-inflammatories (NSAIDs), local anaesthetic, epidural, paracetamol, metamizole and placebo was done. As per the weighted single-arm effects estimate, the global improvement in VAS across all modalities from the starting to day 2 was reported.

Also, epidural analgesia had the greatest improvement in pain scores within the first 24 hours, but at 48 hours it was similar to that of opiates. NSAIDs had similar pain-relief to opiates in the first 24 hours. The use of local anesthetics had minimum overall efficacy. Opiate and non-opiate analgesics had similar VAS scores at baseline and day 1.

To sum up, epidurals are the most effective analgesic modality to be used in the first 24 hours of acute pancreatitis. NSAIDs are a useful opiate sparing substitute.