ABSTRACT
Acute pancreatitis is usually associated with visceral pain. Epidural administration of opioids or alpha2 adrenergic agonists have been used to treat pain associated with pancreatitis or other types of abdominal lesions. Lumbosacral epidural injection of opioids with low lipophilicity such as morphine should provide some relief. Lipophilic opioids such as fentanyl or buprenorphine require delivery closer to the site of afferent input into the spinal cord and may be delivered by an epidural catheter. The catheter tip should be advanced to the thoracolumbar area of the spine. Epidural catheter placement should be done under heavy sedation or anesthesia to prevent patient movement when performing this technique. Interpleural local anesthetic administration may also provide relief for pancreatitis pain. Nerves innervating the cranial abdomen enter the spinal cord in the caudal thoracic region.
