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Thoracic Epidural Analgesia for Acute Pancreatitis With Early Organ Dysfunction (TEA-APOD)

19 juillet 2026 mis à jour par: Xingui Dai, First People's Hospital of Chenzhou

Effect of Thoracic Epidural Analgesia on Organ Support Burden in Patients With Acute Pancreatitis and Early Organ Dysfunction: A Single-Center Randomized Controlled Trial

Acute pancreatitis may cause early respiratory, cardiovascular, or renal dysfunction and may require intensive care and organ support. Thoracic epidural analgesia may improve pain control, reduce systemic opioid exposure, and facilitate gastrointestinal recovery; however, its effect on overall organ support burden remains uncertain.

This is a single-center, prospective, randomized, open-label, parallel-group clinical trial. A total of 150 adults with acute pancreatitis within 72 hours of symptom onset and early respiratory, cardiovascular, or renal dysfunction will be randomized in a 1:1 ratio to receive either ropivacaine-only thoracic epidural analgesia plus standard care or standardized conventional analgesia plus standard care.

The primary outcome is alive and organ support-free days through day 14 after randomization. Secondary and exploratory outcomes include alive and organ support-free days through day 28, organ dysfunction-free days, ventilator-free days, renal replacement therapy-free days, vasoactive drug-free days, 28-day mortality, pain scores, systemic opioid exposure, gastrointestinal and nutritional outcomes, intra-abdominal pressure, inflammatory markers, complications, length of stay, hospital costs, and adverse events related to thoracic epidural analgesia.

Aperçu de l'étude

Statut

Pas encore de recrutement

Les conditions

Intervention / Traitement

Type d'étude

Interventionnel

Inscription (Estimé)

150

Phase

  • N'est pas applicable

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Coordonnées de l'étude

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

  • Adulte
  • Adulte plus âgé

Accepte les volontaires sains

Non

La description

Inclusion Criteria:

Inclusion Criteria:

  1. Age 18 to 75 years, inclusive.
  2. Diagnosis of acute pancreatitis based on at least two of the following three criteria: typical acute upper abdominal pain; serum amylase and/or lipase at least three times the upper limit of normal; or imaging findings consistent with acute pancreatitis.
  3. Time from symptom onset to randomization of 72 hours or less.
  4. Early respiratory, cardiovascular, or renal organ dysfunction, defined as a SOFA-2 subscore of 2 or greater in at least one of these three organ systems, requiring ICU admission for continuous monitoring and treatment. The SOFA-2 score will be calculated using the worst available values during the 24 hours before randomization; for participants admitted to the ICU for less than 24 hours, values available since ICU admission will be used. The organ dysfunction must be newly developed or clearly worsened from the participant's previous stable baseline.
  5. Written informed consent provided by the participant or legally authorized representative.

Exclusion Criteria:

  1. Pregnancy or lactation.
  2. Chronic pancreatitis or acute pancreatitis associated with a pancreatic tumor.
  3. Prior retroperitoneal drainage, endoscopic drainage, surgical necrosectomy, or other invasive intervention before randomization that may substantially alter the natural course of the disease.
  4. Invasive mechanical ventilation before randomization.
  5. Any contraindication to thoracic epidural analgesia, including allergy to local anesthetics; infection at the puncture site; epidural abscess or central nervous system infection; severe spinal deformity or prior spinal surgery that prevents catheterization; intracranial hypertension or severe central nervous system disease; uncorrected coagulation disorder; or anticoagulant or antiplatelet therapy that does not meet neuraxial safety requirements.
  6. Uncorrected shock or persistent hemodynamic instability despite adequate fluid resuscitation and vasoactive drug support.
  7. End-stage renal disease requiring maintenance dialysis before randomization.
  8. Participation in another interventional clinical study within the previous 3 months.
  9. Any other condition that, in the investigator's judgment, makes the participant unsuitable for enrollment.

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

  • Objectif principal: Traitement
  • Répartition: Randomisé
  • Modèle interventionnel: Affectation parallèle
  • Masquage: Aucun (étiquette ouverte)

Armes et Interventions

Groupe de participants / Bras
Intervention / Traitement
Comparateur actif: 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.
Autre: 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.
Autres noms:
  • Analgésie standard
  • Conventional pain management
  • Systemic analgesia
Expérimental: Thoracic Epidural Analgesia Group

Participants will receive standard treatment for acute pancreatitis plus thoracic epidural analgesia using ropivacaine alone. After initial fluid resuscitation, blood pressure stabilization, and safety assessment, thoracic epidural analgesia will be initiated as soon as possible after randomization, preferably within 6 hours, no later than 24 hours after randomization, and before 72 hours from symptom onset.

Epidural catheterization will be performed at T8-T11, preferably T9-T10 or T10-T11, by an investigator qualified to perform neuraxial procedures and trained in the study protocol. After a negative test dose of 1% lidocaine 3 mL, a loading dose of 0.2% ropivacaine 5-10 mL will be administered, followed by continuous infusion of 0.2% ropivacaine at 6-8 mL/hour. The target sensory block is T6-T12 and should cover the main upper abdominal pain area.

Thoracic epidural analgesia will generally continue for 5 days or until ICU discharge if earlier. It may be extended to a maximum of 7
Procédure: Thoracic Epidural Analgesia With Ropivacaine

Thoracic epidural block will be performed by an investigator qualified to perform neuraxial procedures and trained in the study protocol. 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.

Autres noms:
  • THÉ
  • Analgésie péridurale thoracique
  • Thoracic epidural blockade
  • Thoracic epidural catheterization

Que mesure l'étude ?

Principaux critères de jugement

Mesure des résultats
Description de la mesure
Délai
Alive and Organ Support-Free Days Through Day 14 (AOSFD-14)
Délai: From randomization through 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 through day 14

Mesures de résultats secondaires

Mesure des résultats
Description de la mesure
Délai
Organ Failure-Free Days to Day 14
Délai: 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
Délai: 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
Délai: 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
Délai: 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
Délai: 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
Analgesic Target Achievement Rate
Délai: 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
Pain Score
Délai: Baseline, 3-6 hours after intervention initiation, and days 1, 3, 5, and 7

Pain intensity will be assessed using the Numeric Rating Scale (NRS) in conscious and communicative participants, or the Critical-Care Pain Observation Tool (CPOT) in non-communicative critically ill participants.

The NRS is an 11-point scale ranging from 0 (no pain) to 10 (worst possible pain). The CPOT ranges from 0 (no pain) to 8 (worst possible pain). For both scales, higher scores indicate worse pain control (worse outcome).
Baseline, 3-6 hours after intervention initiation, and days 1, 3, 5, and 7

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Parrainer

First People's Hospital of Chenzhou

Les enquêteurs

  • Chaise d'étude: Xingui Dai, PHD, Chen Zhou NO.1 People's Hospital

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude (Estimé)

1 août 2026

Achèvement primaire (Estimé)

1 août 2028

Achèvement de l'étude (Estimé)

1 septembre 2028

Dates d'inscription aux études

Première soumission

7 juillet 2026

Première soumission répondant aux critères de contrôle qualité

7 juillet 2026

Première publication (Réel)

13 juillet 2026

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Réel)

21 juillet 2026

Dernière mise à jour soumise répondant aux critères de contrôle qualité

19 juillet 2026

Dernière vérification

1 juillet 2026

Plus d'information

Termes liés à cette étude

Mots clés

Termes MeSH pertinents supplémentaires

Autres numéros d'identification d'étude

  • TEA-AP-001

Plan pour les données individuelles des participants (IPD)

Prévoyez-vous de partager les données individuelles des participants (DPI) ?

OUI

Description du régime 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.

Délai de partage IPD

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

Critères d'accès au partage 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.

Type d'informations de prise en charge du partage d'IPD

  • PROTOCOLE D'ÉTUDE

Informations sur les médicaments et les dispositifs, documents d'étude

Étudie un produit pharmaceutique réglementé par la FDA américaine

Non

Étudie un produit d'appareil réglementé par la FDA américaine

Non

Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .

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