Postinterventional Pain and Complications of Sonographically Guided Interventions in the Liver and Pancreas

Abstract

Purpose: Sonographically guided interventions in abdominal organs are routine procedures with rare severe complications. However, potential patient discomfort or pain is frequently not addressed in the literature.

Materials and Methods: In a prospective 1-year study, the peri- and postinterventional pain of patients undergoing sonographically guided punctures of the liver and pancreas was analyzed. Data acquisition was done with a standardized questionnaire. This included three numeric rating scales (NRS) ranging from “0” to “10” to be answered at puncture and 1 hour and 4 hours later. Data concerning complications and administered analgesic medication was acquired from the patients’ charts.

Results: 223/274 patients could be analyzed (83 %). 91 women (40.8 %) and 132 men (59.2 %) were included. The mean age was 56.0 yrs. Overall the average level of pain was 2.98 at puncture, 1.21 after 1 hour and 0.71 after 4 hours. In patients with diagnostic biopsies, the pain levels were 3.37(0 h)/1.33(1 h)/0.71(4 h) for liver parenchyma, 2.64(0 h)/0.95(1 h)/0.65(4 h) for focal liver lesions and 3.1(0 h)/1.9(1 h)/1.1(4 h) for pancreatic punctures. The pain levels at therapeutic interventions were 3.00(0 h)/2.00(1 h)/0.50(4 h). Female and younger (< 50 yrs) patients had statistically significantly more pain at puncture and 1 hour postintervention. Only minor complications occurred (0.9 %).

Conclusion: Severe pain after sonographically guided interventions is rare. Most patients suffer only from mild pain postinterventionally.

Zusammenfassung

Ziel: Ultraschallgesteuerte Interventionen sind in der modernen Medizin weitverbreitet und führen nur selten zu schweren Komplikationen. Das individuelle Schmerzempfinden des Patienten steht jedoch nur selten im Zentrum des Interesses.

Material und Methoden: Alle Patienten, die sich innerhalb des Jahres 2009 einer ultraschallgesteuerten Punktion an Leber und Pankreas unterzogen, wurden in die prospektive Studie eingeschlossen. Es erfolgte eine Befragung mittels standardisierten Fragebögen. Der Bogen enthielt drei „Numeric rating scales“, die von „0“ bis „10“ reichen. Diese waren jeweils direkt nach der Punktion, nach 1 h und nach 4 h zu beantworten. Daten zur Schmerzmittelgabe und Komplikationen wurden den Akten entnommen.

Ergebnisse: 223/227 Patienten wurden analysiert (83 %). 91 Frauen (40,8 %) und 132 Männer (59,2 %) wurden eingeschlossen. Das mittlere Alter betrug 56 Jahre. Über alle Interventionen betrug der durchschnittliche Schmerzwert 2,98 zum Zeitpunkt der Intervention, 1,21 nach 1 Stunde und 0,71 nach 4 h. Bei diagnostischen Punktionen waren die Werte 3,37 (0 h)/1,9 (1 h)/0,71 (4) bei Leberparenchym, 2,64 (0 h)/0,95 (1 h)/0,65 (4 h) bei fokalen Leberläsionen und 3,1 (0 h)/1,9 (1 h)/1,1 (4 h) für Punktionen des Pankreas. Bei therapeutischen Eingriffen betrugen die Werte 3,00 (0 h)/2,00 (1 h)/0,5 (4 h). Frauen und jüngere Patienten (< 50 Jahre) hatten signifikant mehr Schmerzen zum Zeitpunkt der Intervention und 1 Stunde später. Es traten nur „minor complications“ auf (0,9 %).

Schlussfolgerung: Starke Schmerzen nach ultraschallgesteuerten Interventionen sind selten, die meisten Patienten leiden nur unter leichten Schmerzen.

Key words

abdomen - biopsy - pain perception

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