Background The most common symptom of acute pancreatitis is upper abdominal pain. Although the mainstay of treatment for abdominal pain of pancreatitis has been meperidine and more recently fentanyl, there has been a movement toward use of morphine as the treatment of choice for pain control in major Medical Centers across the United States, including University of New Mexico Health Sciences Center. This increasing trend is of concern as morphine has been demonstrated to cause spasm of the sphincter of Oddi which causes an increase in pressure within the common bile and pancreatic ducts and could further exacerbate pancreatitis. There is no evidence based study demonstrating safety (or advantage) of morphine in the treatment of abdominal pain in acute pancreatitis. Thus, the purpose of this study is to compare the use of meperidine verus morphine in treatment of the pain of acute pancreatitis in a retrospective manner based upon outcomes.
Method Using Ranson's criteria, patients admitted for acute pancreatitis will be sub-categorized based upon the severity of their condition and then again upon whether they were treated with meperidine or morphine. The patient base will be obtained from a chart review of the University of New Mexico Hospital records from January 1999 through June 2004. Inclusion criteria include primary admission diagnosis of acute alcohol pancreatitis without evidence of mechanical cause, and biochemical evidence supporting this diagnosis. Exclusion criteria include cross over from one pain medication to another, and mechanical intervention to the biliary tree during the hospitalization. For the binary outcome (seizures and mental status changes) the comparisons are performed using Fisher's Exact Test. The two sample T-test is a valid comparison of the variability in the length of stay based upon the treatment options. A total of 250 patients will be included in each arm of the study. The results of this study will be the first to characterize the use of morphine compared to meperidine based upon clinical outcomes.
Results Up to this point a total of 80 patients have met inclusion criteria. At the time of abstract presentation, we plan to present the trial results on 500 patients.
Conclusion Based on the results of this retrospective analysis, the use of morphine as a viable alternative to the treatment of acute pancreatitis will be critically evaluated.