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Yang SX, Chen ML, Xie L, Zhu HB, Liu YL, Sun RJ, Zhao B, Deng XB, Li XT, Sun YS. Procedure-related pain during CT-guided percutaneous transthoracic needle biopsies of lung lesions: a prospective study. Cancer Imaging 2023; 23:61. [PMID: 37308928 DOI: 10.1186/s40644-023-00578-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/29/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND The existing data on the degree of pain in patients during CT-guided percutaneous transthoracic needle biopsy (PTNB) of lung lesions are limited and the factors related to pain are unclear. In this study, we aimed to evaluate the prevalence and severity of pain reported during PTNB and to identify factors associated with increased reported pain. METHODS Patients who underwent PTNB from April 2022 to November 2022 were prospectively evaluated using the numeric rating scale, which assesses subjective pain based on a 0-10 scoring system (0 = no pain; 10 = the worst pain imaginable). The scale divides the scores into three categories: mild pain (1-3 points), moderate pain (4-6 points), and severe pain (7-10 points). Pain scores from 4 to 10 were considered significant pain. Demographic data of patients, lesion characteristics, biopsy variables, complications, the patient's subjective feelings, and pathological result data were analyzed by multivariable logistic regression analysis to identify variables associated with significant pain. RESULTS We enrolled 215 participants who underwent 215 biopsy procedures (mean age: 64.5 ± 9.3 years, 123 were men). The mean procedure-related pain score was 2 ± 2. Overall, 20% (43/215) of participants reported no pain (score of 0), 67.9% (146/215) reported pain scores of 1-3, 11.2% (24/215) reported scores of 4-6, and 0.9% (2/215) reported scores of 7 or higher. Furthermore, non-significant pain (scores of 0-3) was reported during 87.9% (189/215) of the procedures. In the adjusted model, significant pain was positively associated with lesions ≥ 34 mm (p = 0.001, odds ratio [OR] = 6.90; 95% confidence interval [CI]: 2.18, 21.85), a needle-pleural angle ≥ 77° (p = 0.047, OR = 2.44; 95% CI: 1.01, 5.89), and a procedure time ≥ 26.5 min (p = 0.031, OR = 3.11; 95% CI: 1.11, 8.73). CONCLUSIONS Most participants reported no pain or mild pain from CT-guided percutaneous transthoracic needle biopsies of lung lesions. However, those with a larger lesion, a greater needle-pleural angle, and a longer procedure time reported greater pain.
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Affiliation(s)
- Shou-Xin Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52, Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Mai-Lin Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52, Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Lei Xie
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou City, Guangdong Province, 515041, China
| | - Hai-Bin Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52, Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Yu-Liang Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52, Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Rui-Jia Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52, Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Bo Zhao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52, Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Xu-Bo Deng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52, Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Xiao-Ting Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52, Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52, Fu Cheng Road, Hai Dian District, Beijing, 100142, China.
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Mohammed SR, Maharaj D, Dindyal S, Ali K. Endovascular Biopsy of an Inferior Vena Cava Mass: A Case Report. Cureus 2023; 15:e37546. [PMID: 37197124 PMCID: PMC10184737 DOI: 10.7759/cureus.37546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/19/2023] Open
Abstract
We describe the case of an 82-year-old female referred to the vascular clinic for further evaluation and management of suspected inferior vena cava (IVC) thrombosis. She had previously presented to the general practitioner with a one-week history of vague abdominal pain in the right and left loins. Contrast-enhanced magnetic resonance imaging (MRI) of the abdomen and magnetic resonance angiography/magnetic resonance venography (MRA/MRV) revealed a 10 cm filling defect in the IVC, with the inferior margin of ≈5.8 cm proximal to the aortic bifurcation and its superior margin in the intrahepatic portion of the IVC. The filling defect had a transverse diameter of 2.6 cm and displayed heterogenous enhancement with contrast. We performed an endovascular biopsy with fluoroscopy (anteroposterior {AP} and lateral views) being utilized throughout the procedure to locate the mass and position the forceps in the tumor bed. The IVC was accessed via the right common femoral vein with a 10F catheter sheath. The sheath was advanced using the Seldinger technique to within ≈1 cm of the mass; then, a biopsy forceps (Micro-Tech single-use 8.5 mm biopsy forceps, Nanjing, China) was inserted, and six tissue samples were obtained. We report this case to add to the growing evidence that endovascular biopsy of IVC tumors can be performed safely and effectively.
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Affiliation(s)
- Saeed R Mohammed
- Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine Campus, Champs Fleurs, TTO
| | - Dale Maharaj
- Department of Vascular Surgery, Caribbean Vascular and Vein Clinic, Port of Spain, TTO
| | - Shiva Dindyal
- Department of Vascular Surgery, Basildon and Thurrock University Hospitals, Mid and South Essex National Health Service (NHS) Foundation Trust, Essex, GBR
| | - Khaleel Ali
- Department of Radiology, Caribbean Heart Care, St. Clair Medical Center, Port of Spain, TTO
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Xiao L, Wagle S, Schmitz JJ, Hesley GK, Parvinian A, Brinkman NJ, Moynagh MR. Safety and technical success of diphenhydramine as an alternative local anaesthetic agent for radiology procedures. Clin Radiol 2023; 78:e177-e181. [PMID: 36411091 DOI: 10.1016/j.crad.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/22/2022] [Accepted: 10/18/2022] [Indexed: 11/19/2022]
Abstract
AIM To evaluate retrospectively the safety and technical success of subcutaneous diphenhydramine as an alternative local anaesthetic for radiology procedures. MATERIALS AND METHODS Between January 2000 and April 2021, 84 image-guided procedures were performed in 81 adult patients (mean age 61 years, 86% female) using 1% injectable diphenhydramine as a local anaesthetic. Indications were history of severe allergy to "-caine" local anaesthetics in 76 (90%) patients and recent administration of bupivacaine liposomal injectable suspension in eight (10%) patients. Twelve of the 84 (14%) procedures were performed with concomitant moderate sedation. Patient characteristics, procedural techniques, and clinical outcomes were reviewed. Early and delayed (30-day) complications were classified as either related to local diphenhydramine injection or to the procedure itself. Procedure-related complications were gradated using the Clavien-Dindo system. RESULTS Percutaneous biopsy was the most frequently performed procedure (57/84, 67%). Fifty-nine (70%) of the 84 procedures were ultrasound guided. The most common procedural site was the breast (34/84, 40%). All procedures were technically successful. There were two minor injection-related complications related to post-procedural pain. A single minor procedure-related complication involved a patient requiring hospital admission for post-renal biopsy related haematuria. CONCLUSION Injectable diphenhydramine appears to be a safe and effective local anaesthetic alternative in patients with "-caine" class contraindications undergoing radiology procedures. A future prospective trial would be useful to assess the safety profile in an large cohort of patients.
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Affiliation(s)
- L Xiao
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - S Wagle
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - J J Schmitz
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - G K Hesley
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - A Parvinian
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - N J Brinkman
- Department of Pharmacy Services, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - M R Moynagh
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
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The effectiveness and safety of local pleural anesthesia for pain control in patients undergoing CT-guided transthoracic needle biopsy. Eur Radiol 2021; 31:8282-8290. [PMID: 33890148 DOI: 10.1007/s00330-021-07969-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/09/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the effectiveness and safety of pleural anesthesia for CT-guided transthoracic needle biopsy (TNB). METHODS This retrospective study was performed between March 2019 and August 2019 in a tertiary care hospital. Patients undergoing CT-guided TNB received either (a) pleural and skin anesthesia (pleural anesthesia group) or (b) skin anesthesia only (skin anesthesia group). Pain score was reported on a 0-5 numeric rating scale, and pain scores 3-5 were classified as significant pain. The relationship between pleural anesthesia and pain score, significant pain, and pneumothorax was assessed by using multivariable linear and logistic regression models. RESULTS A total of 111 patients (67 men, 66.0 ± 11.4 years) were included (pleural anesthesia group, 38; skin anesthesia group, 73). Pleural anesthesia group reported lower pain score (1.4 ± 1.0 vs. 2.3 ± 1.1, p < 0.001) and less frequent significant pain (18.4% [7/38] vs. 42.5% [31/73], p = 0.020) than skin anesthesia group. Pain score was negatively associated with pleural anesthesia (β = -0.93, p < 0.001) and positively associated with procedure time (β = 0.06, p < 0.001). Significant pain was negatively associated with pleural anesthesia (p = 0.004, adjusted odds ratio [OR] = 0.21 [95% confidence interval: 0.07, 0.61]) and positively associated with procedure time (p < 0.001, adjusted OR = 1.15 [95% confidence interval: 1.07, 1.24]). Pleural anesthesia was not associated with pneumothorax or chest tube placement (p = 0.806 and 0.291, respectively). CONCLUSION Pleural anesthesia reduces subjective pain without increasing the risk of pneumothorax. KEY POINTS • Local pleural anesthesia is a simple method that can be added to the conventional skin anesthesia for CT-guided transthoracic needle biopsy. • The addition of local pleural anesthesia can effectively reduce pain compared to the conventional skin anesthesia method. • This procedure is not associated with an increased risk of pneumothorax or chest tube placement.
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