Regional Anesthesia and Acute Pain ManagementRegional Anesthesia and Acute Pain Management1993-65082687-1394Eco-Vector3624810.17816/RA36248Research ArticleContinuous epidural block in complex intensive therapy of severe acute pancreatitisFrolkovValeriy V.frolkov@rambler.ruKrasnosel’skiyM. Ya-OvechkinA. M-SBIH City clinical hospital #23 “MedSanTrud”SBEI “I.M. Sechenov First Moscow State Medical University” of MHC of RF1503201591384421072020Copyright © 2015, Eco-Vector2015The prospective study included 220 patients with severe acute pancreatitis. From this group 105 individuals received continuous epidural blockade (EB) with 0.2% ropivacain solution for 3-7 days. The rest of patients were enrolled into control group. Continuous EB promoted the decrease of intra-abdomenal pressure and allowed introducing the enteral nutrition 2-3 days earlier. Patients from EB group have less lung complications comparing with control group. Total incidence of purulent intra-abdomenal complications was 20,0% in EB group while in control group - 51,3%. The EB conducting contributed into decrease of period of staying in intensive care unit and in hospital as a whole. The incidence of mortality was 11,4% in EB group while in control group it was 15,6%. We concluded that performing of continuous epidural block at early stage of severe acute pancreatitis as an intensive therapy component results in decreasing of frequency of life-threatening complications and mortality.continuous epidural blockadesevere acute pancreatitisпродленная эпидуральная блокадатяжелый острый панкреатит[Beger H., Isenmann R. Surgical management of necrotizing pancreatitis. Surg Clin North Am. 1999; 79: 783-800.][Dugernier T., Laterre P., Reynaert M. Ascites fluid in severe acute pancreatitis: from pathophysiology to therapy. Acta Gastroenterol Belg. 2000; 63: 264-268.][Dugernier T., Reynaert M., Laterre P. Early multi-system organ failure associated with acute pancreatitis: a plea for a conservative therapeutic strategy. Acta Gastroenterol Belg. 2003; 66: 177-183.][Flint R., Windsor J., Bonham M. Trends in the management of severe acute pancreatitis: interventions and outcome. ANZ J Surg. 2004; 74: 335-342.][Isenmann R., Rau B., Beger H. Bacterial infection and extent of necrosis are determinants of organ failure in patients with acute necrotizing pancreatitis. Br J Surg. 1999; 86: 1020-1024.][Takeda K., Matsuno S., Sunamura M. Surgical aspects and management of actue necrotizing pancreatitis: recent results of a cooperative national survey in Japan. Pancreas. 1998; 16: 316-322.][McKay C., Evans S., Sinclair M. High early mortality rate from acute pancrea-titis in Scotland, 1984-1995. Br J Surg. 1999; 86: 1302-1305.][Hou-Quan Tao., Jing-Xia Zhang., Shou-Chun Zou. Clinical characteristics and management of patients with early acute severe pancreatitis: Experience from a medical center in China. World J Gastroenterol. 2004; 15: 919-921.][Кузнецов Н.А., Аронов Л.С., Харитонов С.В., Бронтвейн А.Т. Возможности первичного экстренного ультразвукового исследования в диагностике и определении тактики лечения больных острым панкреатитом. Анналы хирургии. 2004; 2: 52-58.][Ермолов А.С. и др. Основные причины летальности при остром панкреатите в стационарах г. Москвы. Диагностика и лечение гнойных осложнений панкреонекроза. Труды НИИ CП им. Н.В. Склифосовского. 2001; 153: 4-14.][Жариков О.Г. Прогнозирование гнойно-септических осложнений тяжелого острого панкреатита. Новости хирургии. 2008; 16: 117-125.][Савельев В.С., Гельфанд Б.Р., Гологорский В.А. и соавт. Системная воспалительная реакция и сепсис при панкреонекрозе. Анестезиол. и реаниматол. 1999; 6: 28-33.][Wilmer A. ICU management of severe acute pancreatitis. Eur J Intern Med. 2004; 15: 274-280.][Working Group IAP/APA Acute Pancreatitis Guidelines.IAP/ APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013; 13: 1-15.][Kambhampati S., Park W., Habtezion A. Pharmacologic therapy for acute pancreatitis. World J. Gastroenterol. 2014; 20(45): 16868-16880.][Ai K., Kotake Y., Satoh T. Epidural anesthesia retards intestinal acidosis and reduced port vein endotoxin concentrations during progressive hypoxia in rabbits. Anesthesiology. 2001; 94: 263-269.][Rimback G., Cassuto J., Tolesson P. Treatment of postoperative paralytic ileus by intravenous lidocaine infusion. Anesth. Analg. 1990; 70: 414-419.][Hollmann M., Durieux M. Local anesthetics and the inflammatory response. Anesthesiology. 2000; 93: 858-875.][Takao Y., Mikawa K., Nishina K. et al. Lidocaine attenuates hyperoxic lung injure in rabbits. Acta Anaesth. Scand. 1996; 40: 318-325.][Савельев В.С., Филимонов М.И., Гельфанд Б.Р. Острый панкреатит как проблема ургентной хирургии и интенсивной терапии. Consilium Medicum. 2000; 2; (9): 12-19.][Austrums E., Pupelis G., Snippe K. Postoperative enteral stimulation by gut feeding improves outcomes in severe acute pancreatitis. Nutrition. 2003; 19: 487-491.]