Epidural anesthesia restores pancreatic microcirculation and decreases the severity of acute pancreatitis.

Background and Aims: A decrease in pancreatic microcirculatory blood flow has been involved in the severity of acute pancreatitis. Because epidural anesthesia increases intestinal blood flow, we postulated that epidural anesthesia with bupivacaine might improve the pancreatic hypoperfusion induced by acute pancreatitis and concomitantly decrease the severity of the disease. Methods: In rats injected with taurocholic acid in the biliopancreatic duct, we measured the pancreatic microcirculatory blood flow (laser Doppler flowmetry) and the severity of the disease (amylasemia, metabolic acidosis, and acinar cell necrosis on histologic studies), in the presence or in the absence of epidural anesthesia. Results: Epidural anesthesia with bupivacaine, which had no effect in healthy rats, improved the pancreatic hypoperfusion induced by acute pancreatitis with a concomitant decrease in the severity of metabolic acidosis and a diminished tissue injury. Conclusions: Epidural anesthesia should therefore be considered as a new treatment to prevent the conversion of edematous to necrotizing acute pancreatitis.