Comparison of the incidence of acute kidney injury in patients with acute pancreatitis managed with or without thoracic epidural analgesia: A prospective randomized controlled trial

Background: Acute pancreatitis (AP) is frequently complicated by acute kidney injury (AKI), contributing to increased morbidity and mortality. Thoracic epidural analgesia (TEA) may improve splanchnic perfusion, attenuate inflammation, and reduce renal dysfunction. Methods: In this prospective randomized controlled trial, 88 adults with AP were enrolled; 8 were lost to follow-up. Eighty patients were analyzed and randomized to a TEA group ( n = 40) or a control group ( n = 40). The TEA group received epidural analgesia in addition to standard care. Renal and metabolic parameters, including urine output, serum urea, creatinine, electrolytes, lactate, bicarbonate, and base excess, were monitored. AKI was defined and staged using KDIGO criteria. Statistical analysis was performed using independent t -tests and Chi-square tests, with P < 0.05 considered significant. Results: Baseline characteristics were comparable between groups. Transient hypotension occurred in nine TEA patients and was managed conservatively; no major complications were observed. Postintervention urine output was significantly higher ( P = 0.034) and serum urea significantly lower ( P = 0.016) in the TEA group. Lactate levels were lower ( P = 0.011), bicarbonate levels higher ( P = 0.026), and base excess less negative ( P = 0.033), indicating improved perfusion and metabolic status. AKI occurred in 7/40 patients in the TEA group and 12/40 in controls, a nonsignificant difference ( P = 0.14). However, AKI severity was lower in the TEA group. Conclusion: TEA was associated with improved renal and metabolic parameters and a trend toward reduced AKI incidence and severity in AP, without major adverse effects. Larger multicenter studies are needed for confirmation.