Sex-Differences in Post-Procedural Pain Experiences After Thermal Liver Ablations for Liver Tumors: A Retrospective Study.
Microwave ablation (MWA)
Numerical rating scale (NRS)
Pain intensity
Sex differences
Thermal ablation
Journal
Cardiovascular and interventional radiology
ISSN: 1432-086X
Titre abrégé: Cardiovasc Intervent Radiol
Pays: United States
ID NLM: 8003538
Informations de publication
Date de publication:
04 Sep 2024
04 Sep 2024
Historique:
received:
17
02
2024
accepted:
23
08
2024
medline:
5
9
2024
pubmed:
5
9
2024
entrez:
4
9
2024
Statut:
aheadofprint
Résumé
Literature shows differences in pain experiences between sexes. The exact influence of thermal liver ablation on experienced pain is still not well-known. This study aims to investigate the maximum pain intensity at the recovery between men and women after percutaneous thermal liver ablation. Patients treated with percutaneous thermal liver ablation (radiofrequency or microwave ablation) in Maastricht University Medical Center + between 2018 and 2022 for primary or secondary liver tumors were included retrospectively. Outcomes included maximum numerical rating scale (NRS, scale:0-10) score at the recovery room, prevalence of post-procedural pain (defined as NRS score ≥ 4), duration of anesthesia, length of stay at recovery, and complications. Regression analyses were adjusted for age, ASA-score, BMI, tumor type, maximum diameter of lesion, chronic pain in patients' history, and history of psychological disorder. 183 patients were included of which 123 men (67%). Results showed higher average maximum NRS scores in women patients compared to men (mean:3.88 versus 2.73), but not after adjustments (aß:0.75, 95%CI:-0.13-1.64). Women suffered more from acute post-procedural pain (59% versus 35%; aOR:2.50, 95%CI:1.16-5.39), and needed analgesics more often at the recovery room (aOR:2.43, 95%CI:1.07-5.48) compared to men. NRS score at recovery arrival did not significantly differ (aß:0.37, 95%CI:-0.48-1.22). No differences were seen in the length of stay at the recovery, duration of anesthesia, procedure time, and complication rate. Location of the tumor (subcapsular or deep), total tumors per patient, and distinction between primary and secondary tumors had no influence on the NRS. This retrospective single-center study shows higher post-procedural pain rates after thermal liver ablation in women, resulting in higher analgesics use at the recovery room. The results suggest considering higher dosage of analgesics during thermal liver ablation in women to reduce post-procedural pain. LEVEL OF EVIDENCE 3: Non-controlled retrospective cohort study.
Identifiants
pubmed: 39231889
doi: 10.1007/s00270-024-03851-5
pii: 10.1007/s00270-024-03851-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Izzo F, Granata V, Grassi R, Fusco R, Palaia R, Delrio P, et al. Radiofrequency ablation and microwave ablation in liver tumors: an update. Oncologist. 2019;24(10):e990–1005.
doi: 10.1634/theoncologist.2018-0337
pubmed: 31217342
pmcid: 6795153
Liu M, Huang GL, Xu M, Pan FS, Lu MD, Zheng KG, et al. Percutaneous thermal ablation for the treatment of colorectal liver metastases and hepatocellular carcinoma: a comparison of local therapeutic efficacy. Int J Hyperthermia. 2017;33(4):446–53.
doi: 10.1080/02656736.2017.1278622
pubmed: 28044471
Reig M, Forner A, Rimola J, Ferrer-Fabrega J, Burrel M, Garcia-Criado A, et al. BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. J Hepatol. 2022;76(3):681–93.
doi: 10.1016/j.jhep.2021.11.018
pubmed: 34801630
Adam R, Kitano Y. Multidisciplinary approach of liver metastases from colorectal cancer. Ann Gastroenterol Surg. 2019;3(1):50–6.
doi: 10.1002/ags3.12227
pubmed: 30697610
pmcid: 6345652
de Jong MC, Pulitano C, Ribero D, Strub J, Mentha G, Schulick RD, et al. Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: an international multi-institutional analysis of 1669 patients. Ann Surg. 2009;250(3):440–8.
doi: 10.1097/SLA.0b013e3181b4539b
pubmed: 19730175
Glassberg MB, Ghosh S, Clymer JW, Wright GWJ, Ferko N, Amaral JF. Microwave ablation compared with hepatic resection for the treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis. World J Surg Oncol. 2019;17(1):98.
doi: 10.1186/s12957-019-1632-6
pubmed: 31182102
pmcid: 6558848
Ni JY, Xu LF, Sun HL, Zhou JX, Chen YT, Luo JH. Percutaneous ablation therapy versus surgical resection in the treatment for early-stage hepatocellular carcinoma: a meta-analysis of 21,494 patients. J Cancer Res Clin Oncol. 2013;139(12):2021–33.
doi: 10.1007/s00432-013-1530-1
pubmed: 24072235
Ongiem A, Siriussawakul A, Aungsumat Wangdee BW, Homsud S, Jaiyen T. Assessment of pain severity after radiofrequency ablation in patients with hepatocellular carcinoma. J Med Assoc Thai. 2016;99(5):572–7.
pubmed: 27501613
O’Neill A, Lirk P. Multimodal analgesia. Anesthesiol Clin. 2022;40(3):455–68.
doi: 10.1016/j.anclin.2022.04.002
pubmed: 36049874
Yang MMH, Hartley RL, Leung AA, Ronksley PE, Jette N, Casha S, et al. Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis. BMJ Open. 2019;9(4):e025091.
doi: 10.1136/bmjopen-2018-025091
pubmed: 30940757
pmcid: 6500309
Gramke HF, de Rijke JM, van Kleef M, Kessels AG, Peters ML, Sommer M, et al. Predictive factors of postoperative pain after day-case surgery. Clin J Pain. 2009;25(6):455–60.
doi: 10.1097/AJP.0b013e31819a6e34
pubmed: 19542791
Andreano A, Galimberti S, Franza E, Knavel EM, Sironi S, Lee FT, et al. Percutaneous microwave ablation of hepatic tumors: prospective evaluation of postablation syndrome and postprocedural pain. J Vasc Interv Radiol. 2014;25(1):97–105.
doi: 10.1016/j.jvir.2013.09.005
pubmed: 24286938
Lee S, Rhim H, Kim YS, Choi D, Lee WJ, Lim HK, et al. Percutaneous radiofrequency ablation of hepatocellular carcinomas: factors related to intraprocedural and postprocedural pain. AJR Am J Roentgenol. 2009;192(4):1064–70.
doi: 10.2214/AJR.08.1350
pubmed: 19304715
Kendrick DB, Strout TD. The minimum clinically significant difference in patient-assigned numeric scores for pain. Am J Emerg Med. 2005;23(7):828–32.
doi: 10.1016/j.ajem.2005.07.009
pubmed: 16291435
Gerbershagen HJ, Rothaug J, Kalkman CJ, Meissner W. Determination of moderate-to-severe postoperative pain on the numeric rating scale: a cut-off point analysis applying four different methods. Br J Anaesth. 2011;107(4):619–26.
doi: 10.1093/bja/aer195
pubmed: 21724620
Camacho JC, Petre EN, Sofocleous CT. Thermal ablation of metastatic colon cancer to the liver. Semin Intervent Radiol. 2019;36(4):310–8.
doi: 10.1055/s-0039-1698754
pubmed: 31680722
pmcid: 6823045
van Boekel RLM, Bronkhorst EM, Vloet L, Steegers MAM, Vissers KCP. Identification of preoperative predictors for acute postsurgical pain and for pain at three months after surgery: a prospective observational study. Sci Rep. 2021;11(1):16459.
doi: 10.1038/s41598-021-95963-y
pubmed: 34385556
pmcid: 8361098
Piccioni F, Poli A, Templeton LC, Templeton TW, Rispoli M, Vetrugno L, et al. Anesthesia for percutaneous radiofrequency tumor ablation (PRFA): a review of current practice and techniques. Local Reg Anesth. 2019;12:127–37.
doi: 10.2147/LRA.S185765
pubmed: 31824190
pmcid: 6900282
Pyati S, Gan TJ. Perioperative pain management. CNS Drugs. 2007;21(3):185–211.
doi: 10.2165/00023210-200721030-00002
pubmed: 17338592
Winacoo JN, Maykel JA. Operative anesthesia and pain control. Clin Colon Rectal Surg. 2009;22(1):41–6.
doi: 10.1055/s-0029-1202885
pubmed: 20119555
pmcid: 2780232
Wang J, Yuan X, Guo W, Xiang X, Wu Q, Fang M, et al. Sedation and analgesia for liver cancer percutaneous radiofrequency ablation: fentanyl and oxycodone comparison. Int J Med Sci. 2020;17(14):2194–9.
doi: 10.7150/ijms.47067
pubmed: 32922181
pmcid: 7484665
Puijk RS, de Ziedses Plantes V, Nieuwenhuizen S, Ruarus AH, Vroomen L, de Jong MC, et al. Propofol compared to midazolam sedation and to general anesthesia for percutaneous microwave ablation in patients with hepatic malignancies: a single-center comparative analysis of three historical cohorts. Cardiovasc Intervent Radiol. 2019;42(11):1597–608.
doi: 10.1007/s00270-019-02273-y
pubmed: 31243542
pmcid: 6775535
Yang LL, Ji JS, Wu W, Lei LP, Zhao ZW, Shao GL, et al. Clinical observation of remifentanyl and propofol injection in total intravenous anesthesia for percutaneous radiofrequency ablation. Zhonghua Yi Xue Za Zhi. 2013;93(45):3623–5.
pubmed: 24534317
Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth. 2013;111:52–8. https://doi.org/10.1093/bja/aet127 .
doi: 10.1093/bja/aet127
pubmed: 23794645
pmcid: 3690315
Niesters M, Dahan A, Kest B, et al. Do sex differences exist in opioid analgesia? a systematic review and meta-analysis of human experimental and clinical studies. Pain. 2010;151:61–8. https://doi.org/10.1016/j.pain.2010.06.012 .
doi: 10.1016/j.pain.2010.06.012
pubmed: 20692097