Regional Analgesia in Patients with Acute Pancreatitis

Background : Acute pancreatitis (AP) is one of the most common diseases of the gastrointestinal tract, with a severe form developing in 20% to 30% of patients and associated with mortality rate of 10% to 30%. The recommendations of the working group of the International Association of Pancreatology (2013), the consensus of the World Society of Emergency Surgery Congress (2019), and the recommendations of the American Gastroenterological Association do not include sections on pain management in acute pancreatitis. In the Russian clinical guidelines, analgesia is not even included as part of the basic therapy. For pain relief in AP, nonsteroidal antiinflammatory drugs, opioid analgesics, and regional analgesia methods are used. Objective : To analyze the scientific literature on the use of regional analgesia methods in patients with acute pancreatitis. Materials and methods : The publication search was conducted for the period from 1979 to 2024 using the Elibrary, PubMed and Google Scholar databases with the following search terms: acute pancreatitis, analgesia, epidural analgesia, paravertebral anesthesia, transversus abdominis plane block, thoracic epidural analgesia, paravertebral block, and erector spinae plane block. Articles reporting the use of regional analgesia in AP were included in the analysis. The date of the last search was December 25, 2024. A total of 442 publications were identified, of which 415 were excluded. The remaining 27 publications formed the basis of this review. Results: This review describes celiac plexus blocks, bilateral paravertebral blocks, epidural analgesia, transverse abdominis plane blocks, and a new erector spinae plane block. Numerous studies demonstrate that the use of regional analgesia as part of multimodal analgesia for AP effectively manages pain and significantly improves analgesic quality. Conclusions : Further studies are required to determine the optimal technique for interfascial blocks in acute pancreatitis and to evaluate their efficacy and safety.