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Thoracic Epidural Block for Severe Acute Pancreatitis (TEB-SAP)

7 de julio de 2026 actualizado por: Xingui Dai, First People's Hospital of Chenzhou

Thoracic Epidural Block in Patients With Severe Acute Pancreatitis: A Single-Center, Prospective, Randomized, Open-Label, Parallel-Group Trial

Severe acute pancreatitis is a serious illness that can cause severe abdominal pain, inflammation, increased abdominal pressure, feeding intolerance, and early problems with breathing, circulation, and kidney function. Patients with severe acute pancreatitis often need treatment in the intensive care unit. Pain control is an important part of treatment, but conventional pain medicines, especially opioids, may cause side effects such as respiratory depression, reduced bowel movement, nausea, vomiting, delirium, and delayed enteral nutrition.

Thoracic epidural block is a regional pain-control technique. It may relieve abdominal pain by blocking pain signals and sympathetic nerve activity from the chest and upper abdominal region. This treatment may also reduce the need for systemic opioid medicines, improve bowel function, improve tolerance to enteral nutrition, and reduce the need for early organ support in some patients.

This study is a single-center, prospective, randomized, open-label, parallel-group trial. Adult patients with severe acute pancreatitis will be randomly assigned to either a thoracic epidural block group or a conventional analgesia group. Patients in the thoracic epidural block group will receive continuous thoracic epidural infusion of ropivacaine alone, without epidural opioids such as sufentanil, fentanyl, or morphine. Intravenous pain medicines will be used only before epidural block initiation, as rescue analgesia when epidural pain control is inadequate, or after epidural block is paused, fails, or is discontinued. Patients in the conventional analgesia group will receive standard pain treatment according to clinical practice.

The main goal of this study is to determine whether thoracic epidural block can increase the number of days patients are alive and free from ICU-level organ support during the first 14 days after randomization. ICU-level organ support includes invasive mechanical ventilation, noninvasive ventilation, vasoactive or inotropic drug infusion, and renal replacement therapy. The study will also evaluate pain scores, opioid consumption, enteral nutrition tolerance, intra-abdominal pressure, organ function scores, complications, length of ICU and hospital stay, hospital cost, 28-day mortality, and adverse events related to thoracic epidural block.

Descripción general del estudio

Estado

Aún no reclutando

Condiciones

Intervención / Tratamiento

Tipo de estudio

Intervencionista

Inscripción (Estimado)

120

Fase

  • No aplica

Contactos y Ubicaciones

Esta sección proporciona los datos de contacto de quienes realizan el estudio e información sobre dónde se lleva a cabo este estudio.

Estudio Contacto

Criterios de participación

Los investigadores buscan personas que se ajusten a una determinada descripción, denominada criterio de elegibilidad. Algunos ejemplos de estos criterios son el estado de salud general de una persona o tratamientos previos.

Criterio de elegibilidad

Edades elegibles para estudiar

  • Adulto
  • Adulto Mayor

Acepta Voluntarios Saludables

No

Descripción

Inclusion Criteria:

  1. Age 18 to 75 years.
  2. Diagnosis of acute pancreatitis, defined by at least two of the following three criteria: typical acute upper abdominal pain; serum amylase and/or lipase greater than three times the upper limit of normal; imaging findings consistent with acute pancreatitis on contrast-enhanced CT, MRI, or ultrasound.
  3. Admission or transfer to the study hospital within 72 hours after symptom onset.
  4. Severe acute pancreatitis, or moderately severe acute pancreatitis with early respiratory, cardiovascular, or renal organ dysfunction.
  5. Expected need for hospitalization and continuous clinical observation for at least 72 hours.
  6. Written informed consent provided by the participant or legally authorized representative.

Exclusion Criteria:

  1. Acute exacerbation of chronic pancreatitis.
  2. Acute pancreatitis associated with pancreatic tumor.
  3. Pregnancy or lactation.
  4. Prior percutaneous abdominal drainage, retroperitoneal drainage, endoscopic drainage, necrosectomy, or surgery before randomization that may substantially affect outcome assessment.
  5. End-stage malignant disease or expected survival less than 3 months.
  6. Severe pre-existing cardiac, pulmonary, hepatic, renal, hematologic, immune, or neurological disease judged by investigators to interfere with outcome assessment.
  7. Severe pre-existing neurological disease that prevents assessment of neurological complications.
  8. Coagulopathy or bleeding risk judged to contraindicate epidural catheterization, including severe thrombocytopenia, elevated INR, prolonged APTT, or other clinically significant coagulation abnormality.
  9. Ongoing anticoagulant or antiplatelet therapy for which discontinuation does not meet neuraxial anesthesia safety requirements.
  10. Puncture site infection, epidural abscess, central nervous system infection, or uncontrolled severe systemic infection.
  11. Severe spinal deformity, prior relevant spinal surgery, or anatomical abnormality that prevents safe thoracic epidural catheterization.
  12. Intracranial hypertension, spinal cord disease, radiculopathy, or other central nervous system disorder that contraindicates neuraxial block.
  13. Known allergy to local anesthetics or other study-related medications.
  14. Refractory shock or severe hemodynamic instability not suitable for thoracic epidural block.
  15. Severe psychiatric disease, cognitive impairment, or inability to cooperate with the study without availability of a legally authorized representative.
  16. Participation in another interventional clinical trial within the previous 3 months.
  17. Any other condition that, in the opinion of the investigators, makes the participant unsuitable for enrollment.

Plan de estudios

Esta sección proporciona detalles del plan de estudio, incluido cómo está diseñado el estudio y qué mide el estudio.

¿Cómo está diseñado el estudio?

Detalles de diseño

  • Propósito principal: Tratamiento
  • Asignación: Aleatorizado
  • Modelo Intervencionista: Asignación paralela
  • Enmascaramiento: Ninguno (etiqueta abierta)

Armas e Intervenciones

Grupo de participantes/brazo
Intervención / Tratamiento
Experimental: Thoracic Epidural Block Group

Participants in this group will receive thoracic epidural block and standard treatment for severe acute pancreatitis. Thoracic epidural catheterization will be performed by trained anesthesiologists after assessment of hemodynamic status, coagulation function, infection risk, respiratory status, and baseline neurological status. Epidural infusion will use ropivacaine alone. No epidural opioid, including sufentanil, fentanyl, or morphine, will be added.

After successful initiation of thoracic epidural block and achievement of the analgesic target, routine intravenous opioid analgesia will not be used in this group. Intravenous analgesics will be allowed only as transitional analgesia before epidural block initiation, rescue analgesia when epidural analgesia is inadequate, or analgesia after epidural block is paused, fails, or is discontinued. All systemic analgesic use and opioid consumption will be recorded.
Procedimiento: Thoracic Epidural Block With Ropivacaine

Thoracic epidural block will be performed by trained anesthesiologists. Before catheterization, the clinical team will assess hemodynamic status, coagulation function, antithrombotic medication use, infection risk, respiratory status, and baseline neurological status. The puncture level will be selected according to the participant's condition and operator assessment, generally within the T7-T11 range to cover upper abdominal pain.

After thoracic epidural catheter placement, a test dose of 1%-1.5% lidocaine 3 mL will be administered to exclude intrathecal or intravascular catheter placement. If the test dose is negative, a loading dose of ropivacaine may be administered, followed by continuous thoracic epidural infusion of ropivacaine alone.

No epidural opioid, including sufentanil, fentanyl, or morphine, will be added to the epidural infusion in this study. A recommended regimen is 0.1%-0.2% ropivacaine, initiated at approximately 5 mL/hour and adjusted according to pain score, hemo

Otros nombres:
  • TÉ
  • Analgesia epidural torácica
  • Thoracic epidural blockade
  • Thoracic epidural catheterization
Comparador activo: Conventional Analgesia Group
Participants in this group will receive conventional analgesia and standard treatment for severe acute pancreatitis. Conventional analgesia may include non-steroidal anti-inflammatory drugs, acetaminophen, tramadol, fentanyl, sufentanil, oxycodone, hydromorphone, morphine, dexmedetomidine, or other analgesic and sedative medications according to clinical judgment. Analgesic drugs, doses, routes, duration of administration, rescue analgesia, sedative use, and opioid consumption will be recorded.
Otro: conventional analgesia
Conventional analgesia will be administered according to institutional practice and the participant's clinical condition. The analgesic target is an NRS score of 3 or less in conscious and communicative participants, or a CPOT score of 2 or less in non-communicative critically ill participants. Analgesic drugs, doses, routes, duration of administration, rescue analgesia, sedative use, and opioid consumption will be recorded.
Otros nombres:
  • Analgesia estándar
  • Conventional pain management
  • Systemic analgesia

¿Qué mide el estudio?

Medidas de resultado primarias

Medida de resultado
Medida Descripción
Periodo de tiempo
Alive Organ Support-Free Days to Day 14
Periodo de tiempo: From randomization to day 14
Alive organ support-free days to day 14 is defined as the number of days from randomization to day 14 during which the participant is alive and free of ICU-level organ support. ICU-level organ support includes invasive mechanical ventilation, noninvasive ventilation, continuous infusion of vasoactive or inotropic drugs, and renal replacement therapy. A day will be counted as organ support-free only if the participant is alive and does not receive any of these organ support treatments on that day. Participants who die within 14 days after randomization will be assigned 0 alive organ support-free days.
From randomization to day 14

Medidas de resultado secundarias

Medida de resultado
Medida Descripción
Periodo de tiempo
Organ Failure-Free Days to Day 14
Periodo de tiempo: From randomization to day 14
Number of days from randomization to day 14 during which the participant is alive and free of respiratory, cardiovascular, and renal organ failure. Organ failure is defined as a SOFA subscore of 2 or higher in any of the following systems: respiratory, cardiovascular, or renal. Participants who die within 14 days will be assigned 0 organ failure-free days.
From randomization to day 14
Alive Organ Support-Free Days to Day 28
Periodo de tiempo: From randomization to day 28
Number of days from randomization to day 28 during which the participant is alive and free of ICU-level organ support, including invasive mechanical ventilation, noninvasive ventilation, vasoactive or inotropic drug infusion, and renal replacement therapy. Participants who die within 28 days will be assigned 0 days.
From randomization to day 28
Ventilator-Free Days to Day 28
Periodo de tiempo: From randomization to day 28
Number of days from randomization to day 28 during which the participant is alive and free of invasive mechanical ventilation. Participants who die within 28 days will be assigned 0 ventilator-free days.
From randomization to day 28
Renal Replacement Therapy-Free Days to Day 28
Periodo de tiempo: From randomization to day 28
Number of days from randomization to day 28 during which the participant is alive and free of renal replacement therapy. Renal replacement therapy includes continuous renal replacement therapy and intermittent hemodialysis for acute kidney injury. Participants who die within 28 days will be assigned 0 days.
From randomization to day 28
Vasoactive Drug-Free Days to Day 28
Periodo de tiempo: From randomization to day 28
Number of days from randomization to day 28 during which the participant is alive and free of vasoactive or inotropic drug infusion. Vasoactive or inotropic drugs include norepinephrine, epinephrine, dopamine, vasopressin, dobutamine, or other agents used for shock or circulatory support. Participants who die within 28 days will be assigned 0 days.
From randomization to day 28
Pain Score
Periodo de tiempo: Baseline, 3-6 hours after intervention initiation, and days 1, 3, 5, and 7
Pain intensity will be assessed using the Numeric Rating Scale in conscious and communicative participants or the Critical-Care Pain Observation Tool in non-communicative critically ill participants. Lower scores indicate better pain control.
Baseline, 3-6 hours after intervention initiation, and days 1, 3, 5, and 7
Analgesic Target Achievement Rate
Periodo de tiempo: From randomization to day 7
Total systemic opioid consumption during the first 7 days after randomization, converted to intravenous morphine equivalent dose when applicable.
From randomization to day 7

Colaboradores e Investigadores

Aquí es donde encontrará personas y organizaciones involucradas en este estudio.

Patrocinador

First People's Hospital of Chenzhou

Investigadores

  • Silla de estudio: Xingui Dai, PHD, Chen Zhou NO.1 People's Hospital

Fechas de registro del estudio

Estas fechas rastrean el progreso del registro del estudio y los envíos de resultados resumidos a ClinicalTrials.gov. Los registros del estudio y los resultados informados son revisados ​​por la Biblioteca Nacional de Medicina (NLM) para asegurarse de que cumplan con los estándares de control de calidad específicos antes de publicarlos en el sitio web público.

Fechas importantes del estudio

Inicio del estudio (Estimado)

1 de agosto de 2026

Finalización primaria (Estimado)

1 de agosto de 2028

Finalización del estudio (Estimado)

1 de septiembre de 2028

Fechas de registro del estudio

Enviado por primera vez

7 de julio de 2026

Primero enviado que cumplió con los criterios de control de calidad

7 de julio de 2026

Publicado por primera vez (Actual)

13 de julio de 2026

Actualizaciones de registros de estudio

Última actualización publicada (Actual)

13 de julio de 2026

Última actualización enviada que cumplió con los criterios de control de calidad

7 de julio de 2026

Última verificación

1 de julio de 2026

Más información

Términos relacionados con este estudio

Palabras clave

Términos MeSH relevantes adicionales

Otros números de identificación del estudio

  • TEB-SAP-001

Plan de datos de participantes individuales (IPD)

¿Planea compartir datos de participantes individuales (IPD)?

SÍ

Descripción del plan IPD

Deidentified individual participant data underlying the published results may be made available upon reasonable request after publication of the main study results. Data sharing will require approval by the principal investigator and the institution, and by the ethics committee when applicable. Data will be shared only for scientifically valid analyses and after signing an appropriate data use agreement.

Marco de tiempo para compartir IPD

Beginning 6 months after publication of the main study results and available for 3 years.

Criterios de acceso compartido de IPD

Qualified researchers may submit a written request including research purpose, analysis plan, requested data elements, and data protection measures. Requests will be reviewed by the principal investigator and the institution.

Tipo de información de apoyo para compartir IPD

  • PROTOCOLO DE ESTUDIO

Información sobre medicamentos y dispositivos, documentos del estudio

Estudia un producto farmacéutico regulado por la FDA de EE. UU.

No

Estudia un producto de dispositivo regulado por la FDA de EE. UU.

No

Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .

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