Intra-arterial anaesthetics for pain control in arterial embolisation procedures: a systematic review and meta-analysis

Abstract

Purpose A systematic review to determine the effectiveness of intra-arterial anaesthetics on post- operative pain and opioid analgesia requirements in arterial embolisation procedures. Materials and methods A systematic review of the literature was performed (Embase, PubMed, MEDLINE and the Cochrane Library) from inception to 10th August 2020. Randomised controlled trials (RCTs) and cohort studies that utilised intra-arterial anaesthesia during an embolisation procedure for the purposes of pain control were included. Eligibility was assessed by two investigators independently. Results Eight hundred fifty-nine candidate articles were identified, and 9 studies met the inclusion criteria (6 RCTs and 3 retrospective cohort studies). Four studies were of hepatic chemoembolisation and 5 were of uterine artery embolisation. Five hundred twenty-nine patients were treated in total. All studies used lidocaine as the anaesthetic with doses ranging from 20 to 200 mg, and the anaesthetic was delivered varyingly before, during or after embolisation. Pain intensity was converted to a numeric scale from 0 to 10, and opioid doses were converted to milligram morphine equivalent doses. A random-effects meta-analysis model was used to analyse the results of RCTs, and the results of cohort studies were summarised with a narrative synthesis. The meta-analyses suggested that pain scores were reduced by a mean of 1.02 (95% CI − 2.34 to 0.30; p = 0.13) and opioid doses were reduced by a mean of 7.35 mg (95% CI, − 14.77, 0.06; p = 0.05) in the intervention group however neither finding was statistically significant. No serious adverse events were reported. Conclusion Intra-arterial anaesthetic may slightly reduce pain intensity and post-operative opioid consumption following embolisation, however the results are not statistically significant. There is very limited data available on the effect of anaesthetic on length of hospital admission. Whilst no serious adverse events were reported, there are some concerns regarding the effect of lidocaine on the technical success of embolisation procedures that preclude our recommendation for routine use in embolisation procedures. High quality randomised controlled trials are required to elucidate the dose-response effect of lidocaine on opioid consumption and pain following embolisation, particularly in the first few hours post-operatively, as well as effects on duration of hospital stay.

Pain after Interventional Radiology in Oncology: A Case-Control Study from a 5-Year Cohort

“…The incidence of post-IR pain in cancer patients has not been studied in large cohorts. However, some studies have evaluated pain treatment after cementoplasties [ 5 ], embolization [ 6 ], and tumor ablation [ 14 ] and concluded that pain control was inadequate and that pain medications should be prescribed more liberally during and after tumor ablation [ 3 ] or percutaneous osteosynthesis [ 15 ]. As previously reported, the type of techniques used to treat tumors did not play a predominant role, and pain level and opiate consumption are comparable after radiofrequency and electroporation [ 16 ].…”

“…NVS from 0 to 4 (0, no pain; 1, low pain; 2, medium pain; 3, strong pain; and 4, excruciating pain) was measured in the PACU at least on arrival and exit, and the maximum score was retained for this study [ 6 ]. If the score could not be acquired because of consciousness impairment, the value was deemed non-evaluable.…”

“…Few studies have focused on determining associated factors for postoperative pain and their prevention by intraoperative injection of pain medication, as for surgery [ 1 ]. When such studies have been carried out, they have focused on the postoperative follow-up of a specific treatment, such as chemo-embolization [ 4 ], cementoplasty [ 5 ], or arterial embolization [ 6 ]. The problem of post-IR pain assessment is made even more complex because some procedures are indicated to treat a painful condition.…”

Evidences in Uterine Artery Embolization: A Radiologist's Primer

“…25 Intraarterial use of lignocaine (20-200 mg) into uterine arteries after embolization helps in the reduction of post-procedure pain for 7 hours (half-life of lignocaine 90-120 minutes) with reduced requirement of narcotic dose. 26 Superior hypogastric nerve block (SNBH) effectively reduces procedural pain and decreases the need for opioid analgesic. It is done by instilling 3 mL of 0.5% ropivacaine (75-100 mg) or 15-20 mL of 0.5% bupivacaine at the level below the abdominal aortic bifurcation (L5 level) and the anesthetic effect usually lasts for 8 to 12 hours.…”

Management of Postprocedural Uterine Artery Embolization Pain

“…26 A recent systematic review of various articles studying the use of intraarterial anesthesia in hepatic embolization and UAE showed that it may slightly reduce the intensity of pain and amount of postprocedural opiates used, but their results were not significant prompting the call for further study on its efficacy (►Table 2). 27 This technique is often favored by providers as it does not involve a second procedure and adds minimal time to the overall procedure.…”