Su1291 How Should Be Applied the Premedication in Percutanous Liver Biopsy? : The Roles of Analghesics and Sedatives

Abstract

AIM:Percutaneous needle liver biopsy (PLB) is important for diagnosis of liver disease and is frequently associated with pain and anxiety. This may discourage patients for further biopsies, if needed. Procedure is performed under local anesthesia(LA). No concencus are available on premedication. Some reports suggested benefits of sedation and analghesia, while others, possibility of interferance with patient's cooperation. We use LA and sometimes add Meperidine (Me) or Midazolam (Mi) for PLB premedication. We planned a study to investagate the efficacy of analghesia and sedation for PLB. MATERIALS-METHODS: This was a prospective, randomized, double-blinded, double dummy study. Approval received from local ethic committe. PLB planned, 18-65 years old patients included in study. Written informed consent was obtained. Patients randomized into three premedication groups as placebo (P), Me and Mi and requested to complete the Hospital Anxiety and Depression Scale (HADS) before biopsy. Biopsy site was located with ultrasonography. Then, 15 minutes before biopsy, 1ml %0,9 NaCl sc, 1 mg/kg (max100mg)Me sc, and 0.1 mg/kg (max5mg) Mi iv administered to P, Me and Mi patients, respectively. PLBs were performed by the same skilled operator (SY) for all, placed supine position. After local disinfection, LA with Prilocaine HCL 10 ml apllied to skin and periton beneath. Then PLB applied with 16 G Menghini needle.The patient, then lied on right side or supine, monitored in order to detect complications for 4 hours, then discharged. The day after, the patient asked about biopsy.Visual analog scale (VAS) was used to grade the intensity of the subjects' pain. RESULTS: Each of 3 groups as 30, total 90 patients included in study (62 male, 28 female, mean age 41,6 years). Groups were similar by gender, age, PLB indications, HADS scores prior to PLB (5, 4 and 4,respectively, p:0.735), and VAS score during PLB (4.5, 3, 4,respectively p:0.567). In 3 groups 7,12 and 7 patients (respectively) explained no pain (p:0.412). Other patients explained pain as mild or moderate 63%, 40%, and 66% (respectively, p:0.412). Mean length of liver specimen achieved with PLB was 23±9 mm, and pain level didn't related with (p:0.835). 80/90 patients (88.8%) defined PLB as easy, with all groups similar. PLB defined as uneasy by 20%, 6.7%, and 6.6% patients respectively; there was numeric but not stastical difference (p:0.256). There was difference between P group and other two about the attitude for re-biopsy. Patients agreeing rebiopsy without doubt were 33%,53% and 50% (p,0.035) while anxious about 50%, 30% and 33% (p,0.035) respectively. Patients refusing re-biopsy were 13.3% in P, 6.7% in Me and none in Mi groups. CONCLUSION: Premedication with Me or Mi in PLB would improve tolerance, comfort and attitude against a new PLB, and there is no increased risk related to these agents.