13th Annual Global Embolization Symposium & Technologies
Purpose : After transarterial chemoembolization (TACE), patients are commonly admitted overnight to manage post embolization syndrome symptoms, most notably post procedural pain. However TACE techniques have become more refined, allowing for super-selective treatment. The aim of this retrospective review was to evaluate the post procedural analgesic use by our TACE patients who were admitted overnight and determine the feasibility of same-day discharge following TACE.
Material and Methods : A single-center, retrospective review was performed of patients who underwent conventional TACE (c-TACE) between 2013 and 2017. Per our institutional protocol, all patients were admitted overnight and received patient-controlled analgesia (PCA). Primary end points were amount and frequency of PCA usage. Other factors evaluated were patient disease characteristics (including MELD score, number of lesions, lesion size, number of segments treated, and cause of cirrhosis). Uni-variate and multi-variate analysis using chi-squared and Mann-Whitney tests were used to identify any significant association between the amount of analgesic use and patient disease characteristics.
Results : Of 144 patients who underwent c-TACE from 2013 to 2017, the mean morphine milligram equivalent (MME) usage was 36.5 mg and median usage was 21 mg (range 0-256), which converted to a mean oxycodone equivalent usage of 24.3 mg and a median usage of 16 mg (range 0-170). MELD score had a negative correlation with MME dose (correlation coefficient - 0.17, p=0.034). Patients with hepatitis C had significantly higher average MME doses than other cirrhosis etiologies (p<0.001). There was no correlation between other patient disease characteristics and analgesia usage.
Conclusions : Given that the average MME usage in our patient cohort was well below the standard of other published data in regards to amount prescribed as an outpatient and the CDC recommendation of up to 50 MME per day, it is possible that pain control in most patients post-TACE may be managed as an outpatient without overnight hospitalization. Patients with hepatitis C cirrhosis had significantly higher analgesia usage than patients with other causes of cirrhosis.