Sedation and Analgesia for Liver Cancer Percutaneous Radiofrequency Ablation: Fentanyl and Oxycodone Comparison

Abstract

Background: Sedation and analgesia use in percutaneous radiofrequency ablation (RFPA) for liver cancer is a necessary part of the procedure; however, the optimal medicine for sedation and analgesia for PRFA remains controversial. The aim of this study was to compare the perioperative pain management, haemodynamic stability and side effects between oxycodone (OXY) and fentanyl (FEN) use in patients under dexmedetomidine sedation. Methods: Two hundred and five adults with an American Society of Anaesthesiologists physical status score of I to II were included in this study. Patients were assigned to the OXY (n=101) or FEN (n=104) group. Radiofrequency ablation was performed under spontaneous breathing and with painless anaesthesia administered intravenously. The outcomes included fluctuations in mean arterial pressure, heart rate, side effects and the perioperative numerical rating scale (NRS). Results: Radiofrequency ablation was successfully performed in 205 patients. No significant differences were observed in mean blood pressure fluctuations between the two groups despite the longer durations of ablation and total sedation time in the OXY group. The highest NRS score during the surgery and 1 hour and 2 hours after the surgery were significantly lower in the OXY group than in the FEN group. Heart rate fluctuations were significantly lower in the OXY group than in FEN group throughout the surgery. More patients in the FEN group displayed unwanted body movement and respiratory depression. Conclusions: Both oxycodone and fentanyl can be applied for liver cancer percutaneous radiofrequency ablation; however, oxycodone provides a better patient experience, lower postoperative pain, less respiratory depression and stable haemodynamic fluctuations.

Post Procedural Pain Following Percutaneous Thermal Liver Tumor Ablation under Procedural Sedation and Analgesia: A Single Center Retrospective Cohort Study

“…Previous studies have demonstrated that tumor characteristics such as location, type or size are known risk factors for the occurrence of periprocedural pain [6,7,9,10,27]. In our study, tumor characteristics did not predict post-ablation pain.…”

“…The latter association is also not noted in our study, suggesting a limited effect of tumor type on post procedural pain intensity. One explanation might be that PSA strategies differ between the studies [6,7,9,10]. The depth of sedation varied from light to moderate and moderate to deep.…”

“…face expressions, increasing ventilation rate, tachycardia, hypertension or movement. In all studies reported up till now different combinations of medication were administered [6,7,9,10]. This may vary from midazolam, dexmedetomidine or propofol as sedatives and a range of opioids e.g.…”

“…Based on these studies, an optimal combination of intravenous (i.v.) medication for PSA during thermal ablation induced pain cannot be recommended and remains controversial [6,7,9,10]. Most frequently used and recommended drugs for PSA during thermal ablation are sedatives (e.g.…”

A comparative study of Esketamine-Dexmedetomidine and Sufentanil-Dexmedetomidine for sedation and analgesia in lung tumor percutaneous radiofrequency ablation(PRFA):A randomized double-blind clinical trial

“…Respiratory events due to poor oxygen supply or ventilation are the most common adverse events during extra-operative anesthesia [23]. Activation of µ-opioid receptors in the central nervous system is associated with adverse effects such as over-sedation, respiratory depression and PONV [24].Esketamine stimulates breathing through increasing carbon dioxide sensitive ventilation [23].Studies by Drummond et al on lingual muscle activity and airway obstruction during sedation with Midazolam and Ketamine showed that Ketamine had a bene cial effect on airway patency [25]. There were more patients with respiratory depression in Group S than in Group E. Three patients in Group S and one patient in Group E. The comparison between the two groups was not statistically signi cant.…”