Pain assessment of ultrasound-guided liver biopsy for diffuse parenchymal diseases: a randomized trial comparing intercostal and subcostal techniques

Year 2021, Volume: 7 Issue: 2, 107 - 115, 04.03.2021

Yaşar Türk , Banu Alıcıoğlu , İsmail Devecioğlu

https://doi.org/10.18621/eurj.689738

Abstract

Objectives: Percutaneous liver biopsy is widely used in diffuse liver parenchymal diseases. Comparison of the severity of pain is not properly studied. In this randomized study, pain intensity between the intercostal and subcostal techniques of US-guided Tru-Cut liver biopsy in diffuse liver diseases was compared.

Methods: Between March 2016 and May 2017, all potential study participants referred to the interventional radiology department for ultrasound-guided liver biopsy (n = 245), were assessed for enrollment. The pain intensity at 0, 2, and 4 h post-procedure was compared in two groups using a Numeric Rating Scale (NRS). Premedication was not used. After applying local anesthesia under US-guidance, 18-G automatic biopsy needle free-hand US-guided biopsy was performed.

Results: Immediately after the biopsy (p = 0.0024), and at the 2nd hour (p = 0.0298), NRS of the subcostal group was significantly less than the intercostal group. Furthermore, the need for oral (p = 0.0492) or intramuscular (p = 0.0094) analgesics after the biopsy in the subcostal group was significantly less than the intercostal group. At the evaluation of both groups together, 55.62% of the patients had a mild and 27.22% had a moderate pain score. NRS score decreased with time in each group.

Conclusions: The pain intensity and the need for analgesics were less in the subcostal biopsies. Since intense pain and anxiety may be the cause of loss of the patients after the first biopsy, a subcostal biopsy could be preferred primarily.

Keywords

Image-guided biopsy, Liver, Pain, Ultrasound

References

• 1. Aribaş BK, Arda K, Çiledaǧ N, Aktaş E, Yakut F, Kavak S, et al. Accuracy and safety of percutaneous US-guided needle biopsies in specific focal liver lesions: comparison of large and small needles in 1300 patients. Panminerva Med 2012;54:233-9.
• 2. Howlett DC, Drinkwater KJ, Lawrence D, Barter S, Nicholson T. Findings of the UK national audit evaluating image-guided or image-assisted liver biopsy. Part I. Procedural aspects, diagnosticadequacy, and accuracy. Radiology 2012;265:819-31.
• 3. Papini E, Pacella CM, Rossi Z, Bizzarri G, Fabbrini R, Nardi F, et al. A randomized trial of ultrasound-guided anterior subcostal liver biopsy versus the conventional Menghini technique. J Hepatol 1991;13:291-7.
• 4. Piccinino F, Sagnelli E, Pasquale G, Giusti G. Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies. J Hepatol 1986;2:165-73.
• 5. McGill DB, Rakela J, Zinsmeister AR, Ott BJ. A 21-year experience with major hemorrhage after percutaneous liver biopsy. Gastroenterology 1990;99:1396-400.
• 6. Tan KT, Rajan DK, Kachura JR, Hayeems E, Simons ME, Ho CS. Pain after percutaneous liver biopsy for diffuse hepatic disease: a randomized trial comparing subcostal and intercostal approaches. J Vasc Interv Radiol 2005;16:1215-9.
• 7. Janes CH, Lindor KD. Outcome of patients hospitalized for complications after outpatient liver biopsy. Ann Intern Med 1993;118:96-8.
• 8. Perrault J, McGill DB, Ott BJ, Taylor WF. Liver biopsy: complications in 1000 inpatients and outpatients. Gastroenterology 1978;74:103-6.
• 9. Cadranel JF, Rufat P, Degos F. Practices of liver biopsy in France: results of a prospective nationwide survey. For the Group of Epidemiology of the French Association for the Study of the Liver (AFEF). Hepatology 2000;32:477-81.
• 10. Castéra L, Nègre I, Samii K, Buffet C. Pain experienced during percutaneous liver biopsy. Hepatology 1999;30:1529-30.
• 11. Eisenberg E, Konopniki M, Veitsman E, Kramskay R, Gaitini D, Baruch Y. Prevalence and characteristics of pain induced by percutaneous liver biopsy. Anesth Analg 2003;96:1392-6.
• 12. Pezeshki Rad M, Abbasi B, Morovatdar N, Sadeghi M, Hashemi K. Pain in percutaneous liver core-needle biopsy: a randomized trial comparing the intercostal and subcostal approaches. Abdom Radiol 2019;44:286-91.
• 13. Mayoral W, Lewis JH. Percutaneous liver biopsy: what is the current approach? Results of a questionnaire survey. Dig Dis Sci 2001;46:118-27.
• 14. Riley TR 3rd. Predictors of pain medication use after percutaneous liver biopsy. Dig Dis Sci 2002;47:2151-3.
• 15. Spielberger, C. D. Anxiety as an emotional state. In: Spielberger C. D (editor). Anxiety: Current trends in theory and research Vol. 1, New York, NY, USA: Academic Press; 1972. pp. 3-19.
• 16. Lindner A, Frieser M, Heide R, Wildner D, Neurath MF, et al. Postinterventional pain and complications of sonographically guided interventions in the liver and pancreas. Ultraschall Med 2014;35:159-65.
• 17. Baig MA, Javed W. Pain associated with liver biopsies through percutaneous approach under sonographic guidance-a cross sectional pilot study in a tertiary care hospital. J Ayub Med Coll Abbottabad 2015;27:45-7.
• 18. Brouillette DE, Yoo YK, Chien MC, Rabinovitz M, Tarter RE, Van Thiel DH. Use of midazolam for percutaneous liver biopsy. Dig Dis Sci 1989;34:1553-8.
• 19. Alexander JA, Smith BJ. Midazolam sedation for percutaneous liver biopsy. Dig Dis Sci 1993;38:2209-11.
• 20. Menghini G. One-second needle biopsy of the liver. Gastroenterology 1958;35:190-9.
• 21. Froehlich F, Lamy O, Fried M, Gonvers JJ. Practice and complications of liver biopsy. Results of a nationwide survey in Switzerland. Dig Dis Sci 1993;38:1480-4.
• 22. Scheuer PJ. Liver biopsy size matters in chronic hepatitis: bigger is better. Hepatology 2003;38:1356-8.
• 23. Jensen MP, Karoly P. Self-report scales and procedures for assessing pain in adults. In: Turk DC, Melzack R, eds., Handbook of Pain Assessment. New York, NY, USA: The Guilford Press; 2010: pp.19-44.
• 24. Lund I, Lundeberg T, Sandberg L, Budh CN, Kowalski J, Svensson E. Lack of interchangeability between visual analogue and verbal rating pain scales: a cross sectional description of pain etiology groups. BMC Med Res Methodol 2005;5:31.
• 25. Jensen MP, Turner JA, Romano JM. What is the maximum number of levels needed in pain intensity measurement? Pain 1994;58:387-92.
• 26. Cardella JF, Kundu S, Miller DL, Millward SF, Sacks D; Society of Interventional Radiology. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 2009;20(7 Suppl):S189-91.