Epidural Analgesia for Recurrent Acute Pancreatitis in Early Pregnancy: A Case Report

Abstract

Recurrent acute pancreatitis is a rare presentation in the early trimester of pregnancy. Severe abdominal pain is commonly associated with acute pancreatitis and adequate pain relief is essential to achieve better outcomes. We share the case of a 21-year-old female with 8 weeks of pregnancy who was diagnosed with recurrent acute pancreatitis. The patient complained of continuous pain, moderate to severe in intensity which was not relieved by taking intravenous opioid. Her laboratory reports and imaging studies were consistent with mild acute pancreatitis. Intensity of pain was severe and it was 8 out of 10 in visual analogue scale (VAS). We have performed thoracic epidural at T8-9 intervertebral space for pain management and intensity of pain was assessed. Epidural catheter was kept in situ for 48 hours and intermittent bolus of 3-5 ml of 0.1% plain bupivacaine with 2 μg/ml fentanyl was administered throughout this period. Effective pain relief was achieved (VAS < 3) and general wellbeing was improved significantly. Thus, thoracic epidural analgesia technique provides adequate analgesia and can be considered as an effective modality for pain management in acute pancreatitis.