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Purpose: Acute pancreatitis is associated with severe abdominal pain and nausea. The American College of Gastroenterology recommends treatment of pain with a parenteral opioid; however, data is lacking indicating the safety and efficacy of antiemetics. We evaluated the use of opioid and antiemetic medications and the effect on hospital length of stay.
Methods: This was a retrospective chart review. Patients eligible for enrollment in the study had a primary diagnosis of acute pancreatitis (as determined by ICD9 code) and were admitted to the hospital between September 2008 and October 2011. Patients were excluded if they were < 18 years of age, admitted to the ICU, HIV positive, pregnant, or had necrotizing pancreatitis.
Results: Forty two patients met inclusion criteria; 50% male (n=21) and 79% (n=33) African-American. The 48 hour Ranson score for 86% of patients (n=36) was less than 6. The initial opiates most commonly prescribed included IV morphine for 71% (n=30) of patients and IV hydromorphone for 20% (n=8). Average length of stay for patients receiving morphine was 4.6 (± 4.3) days compared to 2.6 (± 1.1) days with hydromorphone (r = 0.018). Ninety percent of patients received ondansetron as the initial antiemetic. Average length of stay for patients who received ondansetron was 4 ± 3.9 days compared to 3 (± 1.15) days with promethazine (r = -0.0077).
Conclusion: For the treatment of acute pancreatitis, morphine was the most commonly used opiate, and ondansetron was the most commonly used antiemetic. Preliminary analyses indicate that there is almost negligible correlation between initial opioid prescribed, whether morphine or hydromorphone, and hospital length of stay for patients with acute pancreatitis. Similarly, there was negligible correlation between initial antiemetic prescribed, ondansetron or promethazine, and hospital length of stay. Data collection is ongoing.