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VIENNA, Austria — April 21, 2010 — Combined prophylactic analgesia and anxiolytic treatment with tramadol plus lorazepam is significantly more effective than the use of diazepam alone for pain relief of patients undergoing percutaneous liver biopsy.
“We believe that percutaneous liver biopsy is still the gold standard for diagnosis and staging of liver diseases,” said Ella Veitsman, MD, Liver Unit, Rambam Healthcare Campus, Haifa, Israel, on April 17 here at the 45th Annual Meeting of the European Association for the Study of the Liver (EASL 2010).
However, there remains no consensus as to pain prevention and treatment for patients undergoing liver biopsy, and the present emphasis is turning to less invasive and less painful techniques. At the same time, analgesia before liver biopsy is usually avoided due to worries of masking pain that might be indicative of abdominal symptoms.
So to investigate ways of making this procedure more comfortable for the patient, the aim was to compare pain and anxiety levels for the use of 2 prophylactic treatment regimens.
In all, 113 patients were randomised to prophylactic analgesia with sublingual tramadol 50 mg plus oral lorazepam 1 mg (n = 56) or diazepam 5 mg (n = 57). Both treatments were administered 30 minutes prior to liver biopsy.
Patient pain and anxiety levels were determined upon dosing, and 30 minutes and 5 hours post biopsy. Pain was assessed according to a 10-point visual analogue scale (VAS), with anxiety measured according to the State Anxiety Inventory.
There was a significant reduction in pain levels at 30 minutes post biopsy in patients who received tramadol/lorazepam versus diazepam (P = .005).
In patients who received diazepam, 13.8% reported a high level of pain (VAS >7), compared with 3.6% of patients who received tramadol/lorazepam (P = .09).
There were no significant differences between groups for anxiety levels from 30 minutes prebiopsy to 6 hours post biopsy. However, significantly more patients in the tramadol/lorazepam group were willing to undergo recurrent liver biopsy than in the diazepam group (88% vs 6%; P = .002).
[Presentation title: Prophylactic Analgesia for Percutaneous Liver Biopsy. Abstract 114]