EPIPAN
Trial question
What is the role of thoracic epidural analgesia in ICU patients with acute pancreatitis?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
30.0% female
70.0% male
N = 135
135 patients (40 female, 95 male).
Inclusion criteria: adult patients admitted to the ICU with a clinical diagnosis of acute pancreatitis.
Key exclusion criteria: PT < 60%; platelet count < 75 g/L; curative anticoagulant therapy with heparin interrupted for < 8 hours; local infection; active CNS infection.
Interventions
N=65 epidural analgesia and usual care (ropivacaine 2 mg/mL and sufentanil 0.5 mcg/mL administered for at least 72 hours using patient-controlled epidural analgesia plus usual care).
N=70 usual care alone (usual care without epidural analgesia based on current consensual guidelines).
Primary outcome
Number of ventilator-free days from randomization to day 30
30 days
30 days
30.0 days
22.5 days
15.0 days
7.5 days
0.0 days
Epidural analgesia and usual
care
Usual care
alone
No significant
difference ↔
No significant difference in the number of ventilator-free days from randomization to day 30 (30 days vs. 30 days).
Secondary outcomes
No significant difference in death at day 30 (9% vs. 14%; RR 0.65, 95% CI 0.25 to 1.68).
No significant difference in development of ARDS (23% vs. 14%; RR 1.59, 95% CI 0.77 to 3.29).
No significant difference in duration of invasive mechanical ventilation (14 days vs. 6 days; AD 8 days, 95% CI -0.86 to 16.86).
Conclusion
In adult patients admitted to the ICU with a clinical diagnosis of acute pancreatitis, epidural analgesia and usual care were not superior to usual care alone with respect to number of ventilator-free days from randomization to day 30.
Reference
Matthieu Jabaudon, Alexandra Genevrier, Samir Jaber et al. Thoracic epidural analgesia in intensive care unit patients with acute pancreatitis: the EPIPAN multicenter randomized controlled trial. Crit Care. 2023 May 31;27(1):213.
Open reference URL