Abstract
BackgroundPercutaneous liver biopsy (PLB) is the “gold standard” in the diagnosis of liver diseases. A pilot trial has shown pethidine may reduce anxiety and the need for post-procedural pain relief. The aim of this study was to investigate the role of pre-procedural pethidine.MethodsA double-blinded, randomized, placebo-controlled trial was conducted to assess the need for pethidine prior to PLB. 98 patients were randomly assigned to receive either 50 mg pethidine i.v. (n = 48), or an equal volume of 0.9% normal saline (n = 50). PLB was performed with ultrasound guidance after adequate local anaesthesia with xylocaine. Patients were asked to self-evaluate pain experienced using a visual analogue score (0–10) immediately and an hour after PLB. Patients were then followed up 24 hours after the procedure to assess their pain score, retrospective pain score and willingness to have a repeat procedure.ResultsPethidine administration resulted in significantly lower pain scores (0.60 ± 0.1 vs 1.2 ± 0.2, p = 0.006) and required less analgesia (0% vs 10%, p = 0.03) immediately after PLB in comparison to the placebo group. There was no significant difference in the pain score and analgesia requirement one hour after the procedure, the pain score at 24 hours after procedure and retrospective pain score. 94% of all patients of either group are willing to under go a repeat liver biopsy (NS).ConclusionsThe administration of pethidine routinely prior to PLB reduces the immediate post procedural pain but has no lasting effect and does not influence the patients’ decision making process for future investigations.Trial registrationACTRN12614001194651, 13 November 2014
Highlights
Percutaneous liver biopsy (PLB) is the “gold standard” in the diagnosis of liver diseases
Study design and population A randomized, placebo-controlled, double blind study approved by the Lower South Regional Ethics Committee and undertaken at Dunedin Public Hospital (DPH), New Zealand
There were no significant differences in pre-biopsy anxiety score, current analgesic use, liver function test, INR, MELD (Model for End-stage Liver disease) score and number of passes to obtain a sample between the two groups (Table 1)
Summary
Percutaneous liver biopsy (PLB) is the “gold standard” in the diagnosis of liver diseases. A pilot trial has shown pethidine may reduce anxiety and the need for post-procedural pain relief. The aim of this study was to investigate the role of pre-procedural pethidine. Percutaneous Liver biopsy (PLB) remains an essential tool in the diagnosis and management of parenchymal liver disease. It is still considered as the “gold standard” in the diagnosis, assessment and staging of various diseases. PLB has been associated with several complications including post-procedural pain [1]. Pan et al BMC Gastroenterology (2015) 15:33 was to investigate the role of pre-procedural pethidine for percutaneous liver biopsy
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