Percutaneous radiofrequency ablation of hepatocellular carcinomas: factors related to intraprocedural and postprocedural pain.
OBJECTIVE
The purpose of our study was to evaluate the factors related to intraprocedural and postprocedural pain during radiofrequency ablation of hepatocellular carcinomas (HCCs).


METHODS
For this retrospective study, we included 145 patients with 160 HCCs who underwent percutaneous radiofrequency ablation under local and IV conscious sedation from January 2006 to December 2006. Patients' pain was scored using the visual analog scale (VAS) immediately after the procedure. Medical records with CT images were reviewed for patient factors, tumor characteristics, and procedural factors. We determined factors correlated with the higher level of intraprocedural pain and the difference in intraprocedural VAS between a group requiring additional analgesics while hospitalized and a group not requiring more analgesics. Statistical analysis was performed using the two-sample Wilcoxon's rank sum test, the Kruskal-Wallis test, and partial Spearman's correlation analysis.


RESULTS
On univariate analysis, patients with large tumors, previously untreated tumors, tumors adjacent to the parietal peritoneum, and those who had undergone multiple ablations and longer duration of ablation reported a higher VAS during the procedure. A significant correlation was seen between the distance of a tumor from the parietal peritoneum and the VAS. On multivariate analysis, tumor location adjacent to the parietal peritoneum was an independent predictor for a higher level of self-reported pain. A group requiring additional analgesics while hospitalized reported a higher VAS than patients not requiring more analgesics.


CONCLUSIONS
The location of a tumor adjacent to the parietal peritoneum is an independent predictor of higher pain level during percutaneous radiofrequency ablation of HCCs. Modification of intraprocedural anesthesia should be considered in patients with risk factors for increased pain.
Lee
Sanghee
S
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
Rhim
Hyunchul
H
Kim
Young-Sun
YS
Choi
Dongil
D
Lee
Won Jae
WJ
Lim
Hyo K
HK
Shin
Byungseop
B
D000328:Adult; D000368:Aged; D000698:Analgesia / Q000379:methods*; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008113:Liver Neoplasms / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional