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[Procaine infusion for pain treatment of acute pancreatitis: a randomized, placebo-controlled double-blind trial].

Author(s): Wilms B, Meffert KS, Schultes B

Affiliation(s): Interdisziplinares Adipositaszentrum, Kantonsspital St. Gallen, St. Gallen, Schweiz.

Publication date & source: 2010-11, Dtsch Med Wochenschr., 135(46):2290-5. Epub 2010 Nov 9.

Publication type: English Abstract; Randomized Controlled Trial

BACKGROUND AND OBJECTIVE: Acute pancreatitis is commonly associated with severe abdominal pain, making early pain relief a primary goal of the treatment. This study was undertaken to assess the efficacy of a continuous intravenous (i.v.) infusion of procaine compared with that of a placebo infusion in providing pain relief in patients with acute pancreatitis. PATIENTS AND METHODS: 42 patients with acute pancreatitis were prospectively randomized to receive, in a double-blind setting, a continuous i.v. infusion of a 1% solution of procaine (procaine group) or placebo (placebo group, receiving a 0.9% saline solution) on the first three days of treatment in a hospital setting. The maximal infusion rate of the procaine solution was 8 ml/h, i.e. 1.92 g/24 h. The rate and total amount of infused fluid was similar in the placebo group. Additionally buprenorphine (Temgesic, sublingual [s.l.]) were given on demand for additional pain relief. RESULTS: The gender ratio and the severity of the pancreatitis (APACHE II score, Ranson score) were comparable between the two groups, while the patients of the control group were eight years older (50.1 2.3 vs. 58.4 3.1; p = 0.039). The i.v. infusion of procaine did not reduce the demand for buprenorphine in the procaine group and was similar to that in the placebo group (p=0.88). Furthermore, explorative data analysis revealed that patients of the procaine group had higher bodily discomfort and nausea scores and also tended to feel more pain than the patients of the placebo group. DISCUSSION: These data do not indicate a clinically meaningful analgesic effect of i.v. infusion of procaine (maximal amount. 1.92 g/24h) in patients with acute pancreatitis, but suggested that this infusion actually increased the feeling of bodily discomfort and nausea. We thus conclude that a constant i.v. infusion of procaine should no longer be recommended for pain relief in patients with acute pancreatitis anymore. (c) Georg Thieme Verlag KG Stuttgart . New York.

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