Clinical Trials Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2025; 17(4): 101439
Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.101439
Novel multimodal analgesic regimen for perioperative pain management after hepatic artery infusion chemotherapy in patients with advanced hepatocellular carcinoma
Jing Yan, Rui An, Jing-Jing Wang, Min Wang, Qi Zhao, Shen Zhao, Jian Xu
Jing Yan, Rui An, Jing-Jing Wang, Min Wang, Qi Zhao, Shen Zhao, Jian Xu, Department of Interventional Surgery Center, Xijing Hospital, The Fourth Military Medical University, Xi’an 710032, Shaanxi Province, China
Co-first authors: Jing Yan and Rui An.
Author contributions: Yan J and An R designed the research and wrote the first manuscript; Yan J, An R, Xu J, Wang JJ, Wang M, Zhao Q and Zhao S contributed to conceiving the research and analyzing data; Yan J and An R conducted the analysis and provided guidance for the research; all authors reviewed and approved the final manuscript. Yan J and An R contributed equally to this work as co-first authors.
Supported by Beijing Medical Award Foundation of China, No. YXJL-2023-0638-0048.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Xijing Hospital, The Fourth Military Medical University.
Clinical trial registration statement: This study is registered at the Clinical Registry: https://www.chictr.org.cn/ (ChiCTR2300073724).
Informed consent statement: All patients involved in this study have provided written informed consent.
Conflict-of-interest statement: There is no conflict of interest.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian Xu, PhD, Department of Interventional Surgery Center, Xijing Hospital, The Fourth Military Medical University, No. 127 Changle West Road, Xi’an 710032, Shaanxi Province, China. xujian4327@163.com
Received: December 20, 2024
Revised: January 20, 2025
Accepted: February 27, 2025
Published online: April 27, 2025
Processing time: 98 Days and 23.2 Hours
Abstract
BACKGROUND

Hepatic artery infusion chemotherapy (HAIC) is a widely used local therapeutic approach for intermediate to advanced-stage hepatocellular carcinoma (HCC), exhibiting considerable efficacy. However, the prevalence of postoperative pain highlights the importance of pain management. Owing to the limitations inherent in existing pain management strategies, this study investigates and assesses the analgesic effectiveness of a multimodal treatment protocol in mitigating pain after HAIC procedures.

AIM

To provide patients with a more comprehensive and effective pain management strategy.

METHODS

A total of 100 patients with primary HCC who underwent HAIC were randomly assigned to a control group (n = 50) and a multimodal group (n = 50). Baseline characteristics and perioperative data were collected. Upon enrollment, patients in the multimodal group received parecoxib (40 mg) 30 minutes before HAIC, followed by 48 hours of patient-controlled analgesia with sufentanil. In contrast, the control group underwent standard preoperative preparation (psychological support) and received dezocine (5 mg) intraoperatively, with intravenous flurbiprofen (100 mg) administered every 12 hours for 48 hours postoperatively.

RESULTS

Compared to the control group, the multimodal analgesia group exhibited significantly lower resting and movement visual analog scale pain scores at postoperative 0, 2, 4, 6, and 12 hours (P < 0.05). Furthermore, the multimodal group experienced a reduced incidence of postoperative nausea and vomiting, as well as a lower overall frequency of adverse events, compared to the control group (P < 0.05). Patient satisfaction was also significantly higher in the multimodal group than in the control group (P < 0.05).

CONCLUSION

Our study demonstrates that multimodal analgesia is effective in reducing postoperative pain, minimizing adverse reactions, and improving patient satisfaction in HCC patients undergoing HAIC. This approach provides valuable clinical strategies for optimizing pain management in this patient population.

Keywords: Advanced hepatocellular carcinoma; Hepatic artery infusion chemotherapy; Multimodal analgesia regimen; Postoperative pain; Pain improvement

Core Tip: Multimodal analgesia is an approach that combines different analgesic medications and techniques to target multiple pain pathways, enhancing pain relief while minimizing adverse effects. This study investigates the effectiveness of a multimodal regimen in managing pain after hepatic artery infusion chemotherapy procedures.