title: Postembolization syndrome after hepatic transarterial chemoembolization: effect of prophylactic steroids on postprocedure medication requirements.
abstract: OBJECTIVE
  To evaluate the impact of prophylactic use of dexamethasone and scopolamine on analgesic and antiemetic agent requirements after transarterial chemoembolization.
  
  
  METHODS
  A total of 148 patients underwent 316 rounds of chemoembolization for hepatocellular carcinoma at a single institution over a 17-month period. Patient charts were retrospectively reviewed for demographic data, procedural technique, and use of analgesic and antiemetic medications. Patients were grouped into three categories: group A received steroid prophylaxis before and after the procedure, group B received steroid prophylaxis before the procedure only, and group C received no steroid prophylaxis.
  
  
  RESULTS
  Analysis was performed on 125 patients undergoing 252 procedures. Demographics were similar among groups. Overall, 86 (68.8%) were male, and mean age was 62 years (range, 39-82 y). Ninety-one patients (75%) had Child-Pugh class A cirrhosis and 25% had Child-Pugh class B cirrhosis. Dexamethasone was not significantly associated with decreased analgesic agent use (P = .6). Group A patients used significantly fewer antiemetic agents (Δ = 0.89; P = .007) compared with group C. A transdermal scopolamine patch was not associated with reduced use of antiemetic agents (P = .3). Age was inversely associated with analgesic (P <.001) and antiemetic agent use (P = .004). Men received significantly fewer antiemetic agents than women (P = .002), whereas there was no significant difference in analgesic agent use (P = .7).
  
  
  CONCLUSIONS
  The use of steroids did not affect analgesic agent use and had a minor effect on antiemetic requirements. The use of a scopolamine patch was not associated with reduced antiemetic agent use.
authors: Department of Radiology, University of Washington School of Medicine, Seattle, Washington 98195, USA. kogutm@uw.edu
authors: Matthew J
authors: MJ
authors: Kogut
authors: Rush H
authors: RH
authors: Chewning
authors: William P
authors: WP
authors: Harris
authors: Daniel S
authors: DS
authors: Hippe
authors: Siddharth A
authors: SA
authors: Padia
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000932:Antiemetics / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D003907:Dexamethasone / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009294:Narcotics / Q000627:therapeutic use; D009325:Nausea / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D012601:Scopolamine / Q000008:administration & dosage; D013256:Steroids / Q000008:administration & dosage*; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology / Q000517:prevention & control*; D014861:Washington
chemical_list: D000932:Antiemetics; D009294:Narcotics; D013256:Steroids; D003907:Dexamethasone; D012601:Scopolamine