N 2 (183) 2023. P. 56–60

FEATURES OF PERFORMING ABDOMINAL PARACENTESIS IN COMPLICATED COURSE OF ACUTE PANCREATITIS

I. V. Kolosovych, I. V. Hanol, K. O. Lebedieva

Bogomolets National Medical University, Kyiv, Ukrainе

DOI 10.32782/2226-2008-2023-2-10

Introduction. Acute pancreatitis is one of the most common diseases of the abdominal cavity with a high risk of complications, the mortality rate of which can reach 70%.

The aim of the work was to evaluate the effectiveness of paracentesis, drainage of the abdominal cavity using multimodal analgesia with dexketoprofen in the staged treatment of patients with complicated course of acute pancreatitis.

Materials and methods. The results of the treatment of 60 patients with acute pancreatitis were analyzed, who were divided into a comparison group (n=30) – patients who received a staged approach to surgical treatment, and a main group (n=30) – patients who were additionally treated with paracentesis, drainage of the abdominal cavity from the left or right iliac region.

Results. When using paracentesis with drainage of the abdominal cavity at the first stage of treatment of patients with a complicated course of acute pancreatitis, a decrease in procalcitonin indicators was obtained from 0.9±0.6 ng/ml to 0.6±0.5 ng/ml (р<0.001), interleukin-6 from 472.7±66.6 pg/ml to 417.1±82.4 pg/ml (p<0.001) and serum amylase level from 649.3±264.4 units/l to 472.7 ±168.6 units/l (р<0.001). This trend was also observed with intra-abdominal pressure indicators (from 13.6±2.9 mm Hg to 10.8±1.3 mm Hg, p=0.01).

Conclusions. The use of paracentesis with drainage of the abdominal cavity as the first stage in the treatment of patients with acute pancreatitis complicated by enzymatic peritonitis leads to a significant decrease in the level of intra-abdominal pressure by 20,6%, procalcitonin by 32%, interleukin-6 by 12% and serum amylase by 27% (p<0.001). No significant difference in the frequency of infectious complications was found in the studied groups.

Key words: acute pancreatitis, complications, paracentesis, multimodal analgesia.

REFERENCES

  1. Foster BR, Jensen KK, Bakis G, Shaaban AM, Coakley FV. Revised Atlanta Classification for Acute Pancreatitis: A Pictoria Essay. Radiographics. 2016 May–Jun; 36 (3): 675–87. doi: 10.1148/rg.2016150097.
  2. Arvanitakis M, Dumonceau JM, Albert J et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy. 2018 May; 50(5): 524–546. doi: 10.1055/a-0588-5365.
  3. Lu Z, Zhu X, Hua T, Zhang J, Xiao W, Jia D, Yang M. Efficacy and safety of abdominal paracentesis drainage on patients with acute pancreatitis: a systematic review and meta-analysis. BMJ Open. 2021 Aug 9; 11(8): e045031. doi: 10.1136/bmjopen-2020-045031.
  4. Montero Matamala A, Hanna M, Perrot S, Varrassi G. Avoid Postoperative Pain To Prevent Its Chronification: A Narrative Review. Cureus. 2022 Feb 15; 14(2): e22243. doi: 10.7759/cureus.22243.
  5. Kolosovych IV, Bezrodnyi BH, Hanol IV, Kolosovych AI, inventors; Bogomolets National Medical University, patent owner. The method of predicting the possibility of performing laparoscopic intervention in the conditions of urgent surgery. Patent of Ukraine No. 120816. 2020 February 10: 3 s. Available from: https://base.uipv.org/searchINV/search.php?action=viewdetails&IdClaim=265639&chapter=biblio (in Ukrainian).
  6. Komarov MP. Acute pancreatitis. Adapted evidence-based clinical setting. Kyiv: State Expert Center of the Ministry of Health of Ukraine. 2016: 53 s. (in Ukainian).
  7. Muniraj T, Jamidar PA, Nealon WH, Aslanian HR. Endoscopic Management of Pancreatic Fluid Collections. J Clin Gastroenterol. 2017 Jan; 51(1): 19–33. doi: 10.1097/MCG.0000000000000644. PMID: 27548730.
  8. Zerem E, Kunosić S, Zerem D, Boloban A, Zerem O, Zlomužica E. Benefits of abdominal paracentesis drainage performed ahead of percutaneous catheter drainage as a modification of the step-up approach in acute pancreatitis with fluid collections. Acta Gastroenterol Belg. 2020 Apr–Jun; 83(2): 285–293. PMID: 32603048.
  9. Umapathy C, Gajendran M, Mann R et al. Pancreatic fluid collections: Clinical manifestations, diagnostic evaluation and management. Dis Mon. 2020 Nov; 66(11): 100986. doi: 10.1016/j.disamonth.2020.100986.
  10. Hanna M, Montero A, Perrot S, Varrassi G. Tramadol/Dexketoprofen Analgesic Efficacy Compared with Tramadol/Paracetamol in Moderate to Severe Postoperative Acute Pain: Subgroup Analysis of a Randomized, Double-Blind, Parallel Group Trial-DAVID Study. Pain Ther. 2021 Jun; 10(1): 485–503. doi: 10.1007/s40122-020-00228-7.
  11. Anıl A, Kaya FN, Yavaşcaoğlu B, Mercanoğlu Efe E, Türker G, Demirci A. Comparison of postoperative analgesic efficacy of intraoperative single-dose intravenous administration of dexketoprofen trometamol and diclofenac sodium in laparoscopic cholecystectomy. J Clin Anesth. 2016 Aug; 32: 127–33. doi: 10.1016/j.jclinane.2016.02.020.
View article PDF