title: Prophylactic analgesia before percutaneous liver biopsy: a clinical comparative study.
abstract: BACKGROUND
  Liver biopsy remains the gold standard for the diagnosis and staging of liver diseases. Despite being painful, analgesia before liver biopsy is usually avoided due to the notion that pain is minor and due to the concern of masking possible abdominal symptoms. Postbiopsy pain levels were previously mapped for the purpose of analgesia planning.
  
  
  OBJECTIVE
  To compare pain and anxiety levels between two prophylactic treatment regimens, a combination of sublingual tramadol Hcl with oral lorazepam and oral diazepam only.
  
  
  METHODS
  One hundred and thirteen consecutive patients were selected to receive either prophylactic analgesia with sublingual tramadol Hcl (50 mg) flashtabs and oral lorazepam [(1 mg) analgesia group (AG), n=56] or oral diazepam (5 mg) alone [nonAG (NAG), n=57]. Pain and anxiety levels were assessed using Visual Analogue Scale (1-10) and State Anxiety Inventory, respectively, 30 min before, and 30 min and 6 h after the biopsy.
  
  
  RESULTS
  The groups were comparable with respect to baseline characteristics. Thirty minutes after the procedure, pain levels were significantly lower in the AG (mean Visual Analogue Scale ± standard error of the mean, 1.8 ± 0. 3; median=1) compared with the NAG (3.1 ± 0.3, median=3; P<0.005). Patients in the NAG (13.8%), reported high pain intensities (>7) compared with the patients in the AG (3.6%; P=0.09). Six hours after the procedure, pain intensity remained significantly lower in the AG compared with the NAG (0.8 ± 0.1 vs. 1.5 ± 0.2; P<0.005). Anxiety levels were comparable.
  
  
  CONCLUSIONS
  Prophylactic combination of short-acting tramadol and lorazepam is effective, safe, and can be used routinely before liver biopsy.
authors.affiliation: Liver Unit, Acute Pain Service, Rambam Health-Care Campus, Technion Israel Institute of Technology, Haifa, Israel.
authors.forename: Rimma
authors.initials: R
authors.lastname: Kramskay
authors.forename: Alex
authors.initials: A
authors.lastname: Tansky
authors.forename: Elon
authors.initials: E
authors.lastname: Eisenberg
authors.forename: Ella
authors.initials: E
authors.lastname: Veitsman
authors.forename: Yaacov
authors.initials: Y
authors.lastname: Baruch
mesh_terms: D000328:Adult; D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D014151:Anti-Anxiety Agents / Q000008:administration & dosage; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control; D001707:Biopsy, Needle / Q000009:adverse effects* / Q000379:methods; D003975:Diazepam / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008140:Lorazepam / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement / Q000379:methods; D011569:Psychiatric Status Rating Scales; D014147:Tramadol / Q000008:administration & dosage
chemical_list: D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D014147:Tramadol; D008140:Lorazepam; D003975:Diazepam