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A pooled analysis was undertaken of the improvement in pain scores as reported on visual analogue scale (VAS) on day 0, day 1 and day 2.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twelve RCTs were identified including 542 patients. Seven trial drugs were compared: opiates, non\u2010steroidal anti\u2010inflammatories (NSAIDs), metamizole, local anaesthetic, epidural, paracetamol, and placebo. Across all modalities, the pooled VAS scores showed global improvement from baseline to day 2. Epidural analgesia appears to provide the greatest improvement in VAS within the first 24 h but is equivalent to opiates by 48 h. Within 24 h, NSAIDs offered similar pain\u2010relief to opiates, while placebo also showed equivalence to other modalities but then plateaued. Local anaesthetics demonstrated least overall efficacy. VAS scores for opiate and non\u2010opiate analgesics were comparable at baseline and day 1. The identified RCTs demonstrated significant statistical and methodological heterogeneity in pain\u2010relief reporting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There is remarkable paucity of level 1 evidence to guide pain management in AP with small datasets per study. Epidural administration appears effective within the first 24 h of AP although infrequently used and featured in only a single RCT. NSAIDs are an effective opiate sparing alternative during the first 24 h.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-021-06420-w","type":"journal-article","created":{"date-parts":[[2022,1,7]],"date-time":"2022-01-07T06:07:52Z","timestamp":1641535672000},"page":"878-890","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Analgesia in the Initial Management of Acute Pancreatitis: A Systematic Review and Meta\u2010Analysis of Randomised Controlled Trials"],"prefix":"10.1002","volume":"46","author":[{"given":"Navamayooran","family":"Thavanesan","sequence":"first","affiliation":[{"name":"Department of General Surgery Salisbury Hospital Foundation Trust Salisbury UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"White","sequence":"additional","affiliation":[{"name":"Department of General Surgery Royal Hampshire County Hospital Winchester 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