Hepatic Hilar and Celiac Plexus Nerve Blocks as Analgesia for Doxorubicin-Eluting Microsphere Chemoembolization Procedures for Hepatocellular Carcinoma: A Nonblinded Randomized Clinical Trial

Bessar, Ahmed Awad; Nada, Mohamad Gamal; Wadea, Fady M.; Elsayed, Ashraf E.; Farag, Ahmed; Bessar, Manar A.

doi:10.1016/j.jvir.2021.04.023

Cited by 5 publications

(4 citation statements)

References 16 publications

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“…This result is because the feeding arteries for the central portion of the liver are usually small, which may end in incomplete embolization of the tumor. [20][21][22] This study has several limitations. First, this was a retrospective study.…”

Section: Discussionmentioning

confidence: 96%

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Tumor enhancement ratio with unenhanced imaging is an independent prognostic factor for patients with hepatocellular carcinoma after transarterial chemoembolization

Yang

Deng

et al. 2021

J Int Med Res

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Objective To investigative whether the odds tumor enhancement ratio (OTER) on cross-sectional imaging is a prognostic factor for hepatocellular carcinoma after transarterial chemoembolization (TACE). Methods This study involved 126 patients who underwent TACE from May 2015 to March 2019. The signal intensity/Hounsfield units (HU) was measured by placing regions of interest on the tumor and surrounding liver in unenhanced and arterial-phase contrast-enhanced cross-sectional images. The OTER was calculated as follows: OTER = (HUTUMORart − HUTUMORun)/ (HULIVERart − HULIVERun). Univariate analysis was performed to determine the factors associated with overall survival (OS). Variables with a P value of <0.10 were included in the multivariate Cox regression analysis. Results The median OS was 757 days. Tumors with a peripheral location, small size, and low OTER had better OS than those with a central location, large size, and high OTER. OS did not differ according to the extent of tumor involvement or tumor enhancement pattern. The OTER, tumor location, and size were included in the multivariate Cox regression analysis. A low OTER was the predictor of better OS. Conclusion A high OTER is a risk factor for poor OS in patients undergoing TACE. This should be taken into consideration before the procedure.

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Section: Discussionmentioning

confidence: 96%

“…This result is because the feeding arteries for the central portion of the liver are usually small, which may end in incomplete embolization of the tumor. 20–22…”

Section: Discussionmentioning

confidence: 99%

Tumor enhancement ratio with unenhanced imaging is an independent prognostic factor for patients with hepatocellular carcinoma after transarterial chemoembolization

Yang

Deng

et al. 2021

J Int Med Res

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“…A 2021 study by Bessar et al of 92 patients receiving HHNBs alongside doxorubicineluting embolic transarterial chemoembolization (DEB-TACE) therapy for hepatocellular carcinoma (HCC) also found no significant differences in post-procedure hospital stay length or adverse event incidence, but groups did observe improvements in pain ratings and opioid consumption [19]. An earlier study, published by Coldwell et al, evaluated the effect of celiac plexus blocks on intra-and post-procedure pain during and after TAE.…”

Section: Discussionmentioning

confidence: 99%

“…Along with providing patients with symptomatic relief, it is critical to explore interventions that can decrease and even prevent PES from occurring after embolization procedures. Several such non-opioid therapies and techniques have been described to help mitigate PES, including intravenous N-acetylcysteine, intravenous dexamethasone, intraarterial dexamethasone, intraarterial lidocaine, and specific peripheral nerve blocks such as celiac, paravertebral, and hepatic hilar nerve blocks (HHNBs) [14][15][16][17][18][19][20]. Peripheral nerve blocks are an appealing adjunct to embolization therapies as they represent a non-opioid analgesic option, which is quick, inexpensive, and effective.…”

Section: Introductionmentioning

confidence: 99%

Hepatic Hilar Block as an Adjunct to Transarterial Embolization of Neuroendocrine Tumors: A Retrospective Review of Safety and Efficacy

Jain,

Blume,

Rodriguez

et al. 2023

Cancers

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Purpose: This study investigates whether hepatic hilar nerve blocks (HHNB) provide safe, effective analgesia in patients with neuroendocrine tumors (NET) treated with transarterial embolization (TAE). Methods: The retrospective study included all NETs treated with TAE or TAE + HHNB from 1/2020 to 8/2022. Eighty-five patients (45 men), mean age 62 years, were treated in 165 sessions (TAE, n = 153; TAE + HHNB, n = 12). For HHNBs, ≤10 mL bupivacaine HCl 0.25% ± 2 mg methylprednisolone were injected under ultrasound guidance. The aims were to assess safety of HHNB and reduction in pain. Groups were compared with Pearson’s chi-squared and Wilcoxon rank sum tests. Logistic regression assessed independent risk factors for pain. Results: No immediate complications from HHNBs were reported. No difference in incidence of major complications between TAE and TAE + HHNB one month post-embolization was observed (7.19% vs. 8.33%, p = 0.895). No differences in mean length of hospital stay after treatment were observed (TAE 2.2 days [95%CI: 1.74–2.56] vs. TAE + HHNB 2.8 days [95%CI: 1.43–4.26]; p = 0.174). Post-procedure pain was reported in 88.2% of TAE and 75.0% of TAE + HHNB patients (p = 0.185). HHNB recipients were more likely to use analgesic patches (25.0% vs. 5.88%; p = 0.014). No other differences in analgesic use were observed. Conclusions: HHNBs can safely be performed in patients with NETs. No difference in hospital stays or analgesic drug use was observed. Managing pain after TAE is an important goal; further study is warranted.

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Neurological pain relief interventional radiology procedures

et al. 2023

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Hepatic Hilar and Celiac Plexus Nerve Blocks as Analgesia for Doxorubicin-Eluting Microsphere Chemoembolization Procedures for Hepatocellular Carcinoma: A Nonblinded Randomized Clinical Trial

Cited by 5 publications

References 16 publications

Tumor enhancement ratio with unenhanced imaging is an independent prognostic factor for patients with hepatocellular carcinoma after transarterial chemoembolization

Tumor enhancement ratio with unenhanced imaging is an independent prognostic factor for patients with hepatocellular carcinoma after transarterial chemoembolization

Hepatic Hilar Block as an Adjunct to Transarterial Embolization of Neuroendocrine Tumors: A Retrospective Review of Safety and Efficacy

Neurological pain relief interventional radiology procedures

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