Purpose: 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.
Methods: 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).
Results: 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).
Conclusions: 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.