title: Chemoembolization for hepatocellular carcinoma: effect of intraarterial lidocaine in peri- and post-procedural pain and hospitalization.
abstract: OBJECTIVE
  To assess the efficacy of intraarterial lidocaine on peri- and post-procedural pain and on length of hospital stay in hepatocellular carcinoma (HCC) patients undergoing chemoembolization.
  
  
  METHODS
  Twenty-eight patients (19M, 9F, age range 49-76) who underwent hepatic chemoembolization at our Institution between March 2000 and February 2002 were included in the study. Group A consisted of 14 patients who received intraarterial lidocaine immediately before and during chemoembolization, while in the 14 patients of group B lidocaine was substituted with saline solution. The doses of centrally acting narcotics (tramadol) administered periprocedurally and in the three days following the procedure were compared, as were the hospitalization times. Subjective pain was measured using the visual analogue scale. Chemoembolizations were performed with an emulsion of lipiodol, cisplatin and epirubicin followed by embolizing material (gelfoam of Contour particles) in order to achieve complete blood flow stop in the proper hepatic artery.
  
  
  RESULTS
  No side effects were noted that could be due to systemic administration of lidocaine. All patients experienced some degree of post-embolization syndrome. Periprocedural, day 1 and day 2 post chemoembolization dosages of tramadol were significantly lower in group A with respect to group B patients. No group A patient required analgesia on day 3. No statistical difference was observed in time persistence of nausea and vomiting, fever and hospitalization time between the two patient groups.
  
  
  CONCLUSIONS
  Intraarterial administration of lidocaine before and during chemoembolization is a safe and effective method for preventing or reducing peri- and post-procedural pain and dosage of narcotic analgesics in patients with HCC. Hospitalization times did not differ significantly between the two groups, probably because of the other components of post-embolization syndrome, such as fever, nausea and vomiting.
authors.affiliation: Dipartimento Assistenziale di Radiologia e Radioterapia, Università Federico II, Naples, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Romano
authors.forename: Angela
authors.initials: A
authors.lastname: Giojelli
authors.forename: Oscar
authors.initials: O
authors.lastname: Tamburrini
authors.forename: Marco
authors.initials: M
authors.lastname: Salvatore
mesh_terms: D015746:Abdominal Pain / Q000139:chemically induced* / Q000188:drug therapy*; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D007902:Length of Stay / Q000706:statistics & numerical data; D008012:Lidocaine / Q000008:administration & dosage*; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage; D010147:Pain Measurement; D014147:Tramadol / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D009294:Narcotics; D014147:Tramadol; D008012:Lidocaine