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Wendy Robson

wendy.robson2@nuth.nhs.uk


Apr 17, 08 - 1:33 PM 		Pancreatitis

Hi all,

I was hoping that some one can help. I am about to start developing some guideline for the analgesia management fo patient with acute pancreatitis. I need options for patients who are drinking/eating or are nil-by-mouth. We find that these patients come in over the weekend and are given IV bolues of Morphine and are then refered to us (Acute Pain Service) to sort out. We try and stick to oramorph for the patients tolerating fluids and PCA's for the N-B-M patients.

Has any one already developed any guidelines that you wouldn't mind sharing.

Thanks

Wendy
Dee



Apr 17th, 2008 - 3:45 PM 		Re: Pancreatitis

Interesting topic. We do the same as you and have no specific guidelines for pancreatitis.

Recently, have had some patients prescribed pethidine PCA as "morphine affects the sphincter of Oddie"

Have found few, old, references regarding this but the evidence seems to be that all opioids have a similar effect and there is no advantage to using pethidine.

Any further info would be welcome.
Jayne



Apr 18th, 2008 - 4:17 PM 		Re: Pancreatitis

We tend also to stick with oramorph in patients who are able to take orally. In patients who are nil by mouth we either use a Morphine PCA, (we stopped using Pethidine because of the risk of norpethidine toxicity) or continuous epidural infusion.
Simon Higgs



Apr 23rd, 2008 - 1:48 PM 		Re: Pancreatitis

For nil orally patients, depending on severity, morphine PCA or subcutaneous oxynorm as required.

Those who can take oral- oxycodone used, normally PRN.

Also regular paracetamol and anti-inflammatory unless contrindicated.

I believe there is some info to say that oxycodone may be a better opioid analgesic for pancreatitis (Don't quote me!)


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