Lee S H, Hahn S T, Park S H
Department of Radiology, St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
Cardiovasc Intervent Radiol. 2001 Nov-Dec;24(6):368-71. doi: 10.1007/s00270-001-0073-z. Epub 2001 Nov 8.
Patients undergoing transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) commonly have significant post-procedural abdominal pain necessitating narcotic administration. It is known that intraarterial administration of lidocaine is effective in controlling the pain during the procedure. However, optimum timing of the lidocaine administration is not precisely known. The purpose of this study was to assess the efficacy of intraarterial lidocaine administration for control of pain resulting from TACE and to evaluate the optimal timing of administration.
In a prospective trial, 113 consecutive patients with HCC who underwent TACE were classified into three groups: those who received a lidocaine bolus intraarterially immediately prior to TACE (group A, n = 30), those who received lidocaine immediately after TACE (group B, n = 46), and those who did not received lidocaine (group C, n = 37). Incidence and degree of post-procedural pain was assessed using a subjective method (visual analogue scales scored from 0 to 10) and an objective method (amount of post-procedural analgesics).
The incidence of post-procedural pain in group A (16.7%) was significantly lower than that of group B (38.3%; p = 0.005). The mean pain score was 3.0 in group A and 4.8 and 3.1 in groups B and C, respectively. The mean dose of analgesic used after the procedure in group A (25.0 mg) was significantly lower than those in group B (52.9 mg) and group C (41.0 mg; p = 0.002).
Pre-TACE intraarterial administration of lidocaine is much more effective than post-TACE administration in reducing the incidence and the severity of post-procedural pain. Furthermore, in order to reduce the incidence of post-procedural pain and dose of post-procedural analgesics, we recommend routine pre-TACE administration of lidocaine because post-procedural pain might developed even in patients who did not feel any pain during the TACE.
接受经动脉化疗栓塞术（TACE）治疗肝细胞癌（HCC）的患者术后常伴有严重的腹痛，需要使用麻醉剂。已知动脉内注射利多卡因可有效控制术中疼痛。然而，利多卡因的最佳给药时间尚不清楚。本研究的目的是评估动脉内注射利多卡因控制TACE所致疼痛的疗效，并评估最佳给药时间。
在一项前瞻性试验中，113例连续接受TACE的HCC患者被分为三组：TACE前立即动脉内注射利多卡因的患者（A组，n = 30）、TACE后立即注射利多卡因的患者（B组，n = 46）和未接受利多卡因的患者（C组，n = 37）。采用主观方法（视觉模拟评分，0至10分）和客观方法（术后镇痛药用量）评估术后疼痛的发生率和程度。
A组术后疼痛发生率（16.7%）显著低于B组（38.3%；p = 0.005）。A组的平均疼痛评分为3.0，B组和C组分别为4.8和3.1。A组术后使用的平均镇痛剂量（25.0 mg）显著低于B组（52.9 mg）和C组（41.0 mg；p = 0.002）。
TACE前动脉内注射利多卡因在降低术后疼痛的发生率和严重程度方面比TACE后注射更有效。此外，为了降低术后疼痛的发生率和术后镇痛药的剂量，我们建议常规在TACE前注射利多卡因，因为即使在TACE期间没有感到任何疼痛的患者中也可能出现术后疼痛。
