Interventional Oncology: Ablation

Assessment of pre-emptive multimodal analgesia to reduce post-procedural opioid requirements in patients undergoing liver microwave ablation

Tuesday, March 23, 2021

10:50 AM – 10:59 AM ET

Author/Co-author(s)

NJ

Nicholos Joseph, BS

Medical Student

Presenting Author(s)

AS

Avik Som, MD, PhD

IR/DR Resident

Author/Co-author(s)

John Di Capua, MD, MHS

Resident
JH

Junjian Huang, MD

Assistant Professor
MO

Melvin Omodon, MD

Interventional Radiologist
ND

Nicole Davis

Researcher
CP

Clara Pau

Researcher
SL

Sarah Low, MD

Resident Physician
BK

Brinda Kamdar, MD

Assistant Professor
PS

Peter Stefanovich, MD

Assistant Professor
RA

Ronald Arellano, MD

Associate Professor
Rafael Vazquez, MD

Director, Anesthesia for Interventional Radiology
RU

Raul N. Uppot, MD

Assistant Professor

Purpose: Microwave ablation (MWA) of liver tumors is associated with post-ablation pain in up to 30% of patients. (1,2) In the surgery and anesthesia literature, protocols of enhanced recovery after surgery (ERAS) have been studied and applied clinically. (3,4) Central to the ERAS protocols is multimodal pre-emptive analgesia, with the goal of decreasing opioid consumption and post-operative pain, while increasing patient safety and satisfaction. This study evaluated the effect and safety of an evidence-based pre-emptive multimodal analgesic regimen in reducing total opioid requirements in patients undergoing liver MWA.

Materials and Methods: This is a single center retrospective review of 207 patients (M:F=142:65, mean age = 66 ± 9.9 years) who underwent 244 image-guided percutaneous liver MWA consecutively between January 2017-December 2019. Cases with pre-procedural multimodal analgesia (PPMA) (191 procedures) were compared to cases without PPMA (53 procedures). PPMA included premedication with ≥1 analgesic (acetaminophen, celecoxib, gabapentin, tramadol, or topical lidocaine patch). The primary outcomes measured were total opioid utilization (intra-procedural and post-procedural) reported in morphine milligram equivalents (MME), patient reported pain via a visual analog scale (VAS), and post-procedure respiratory events (PPRE) defined as any airway rescue manevure for hypoxia (SpO2< 90%).

Results: Within the PPMA group, postoperative MME (3.97mg vs 8.70mg, p=0.02) and visual analog pain score at > 120 min post-procedurally (2.05 vs 3.12, p=0.03) was significantly reduced. There was no difference in hospital admissions (23% vs 21%, p=0.74), post procedure ketorolac (8.11mg vs 7.64mg, p=0.80), or post procedure tramadol (6.12 mg vs 2.83 mg , p=0.27). There were no PPRE events recorded.

Conclusion: In patients undergoing liver MWA for hepatic neoplasms, administration of PPMA was safe and resulted in less total opioid utilization and lower patient-reported pain. Utilization of PPMA for MWA of liver tumors can significantly reduce patient pain post-procedurally and decrease the amount of opioid medications prescribed.

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References: 1. Andreano A, Galimberti S, Franza E, Knavel EM, Sironi S, Lee FT, et al. Percutaneous microwave ablation of hepatic tumors: Prospective evaluation of postablation syndrome and postprocedural pain. J Vasc Interv Radiol. 2014;25(1):97–105.

2. Simon CJ, Dupuy DE, Mayo-Smith WW. Microwave ablation: principles and applications. Radiographics. 2005;25(Suppl 1):S69-83.

3. Ljungqvist O. ERAS - Enhanced Recovery after Surgery: Moving Evidence-Based Perioperative Care to Practice. J Parenter Enter Nutr. 2014;38(5):559–66

4. Semenkovich TR, Hudson JL, Subramanian M, Kozower BD. Enhanced Recovery After Surgery (ERAS) in Thoracic Surgery. Semin Thorac Cardiovasc Surg. 2018;30(3):342–9.