JCNRJournal of Clinical and Nursing Research2208-36852208-3693Bio-Byword Scientific Publishing Pty. Ltd.10.26689/jcnr.v9i10.12535ArticleThe Effectiveness and Safety of Multimodal Pre-Emptive Analgesia in the Perioperative Period of Mid to Advanced Hepatocellular Carcinoma Undergoing TACEhttps://artdesignp.com/journal/JCNR/9/10/10.26689/jcnr.v9i10.12535LiChunhong,ZhangNan,WuYanqin,YuXiaoping,DengShanshan,LiuQingmiao,LiJiaping20259102025-10-31Objective: To evaluate the analgesic effect and safety of hydromorphone hydrochloride in PCIA combined with flurbiprofen axetil and pre-emptive analgesia in patients with TACE treatment for hepatocellular carcinoma. Methods: Backward observation was made on 90 patients with advanced liver carcinoma who performed TACE treatment in the First Affiliated Hospital of Sun Yat-sen University from January 2022 to October 2023, dividing them into Group A (continuous pump injection of 6 mg hydromorphone + 50mg flurbiprofen ester as background injection for 2 ml/h, additional single injection of 3 ml/10min, 15 minutes before surgery) and Group B (intravenous injection of 50 mg flurbiprofen ester during the operation, additional injection of tramadol 100 mg intramuscular injection if necessary). Groups were compared and analyzed at different time points in surgery and post-operation time from pain level (NRS), side effects, inflammatory indexes (PCT, IL-6), satisfaction rate. Result: NRS scores at 5 time points, during operation, immediately post-surgery, 12, 24 hours post-operation, Group A were significantly lower than Group B (Group A during operation 3.0, immediate postoperation 3.0 to 24h 1.0; Group 4.0 to 24h 1.0, all P > 0.05). The rate of adverse reactions were comparable between the two groups (all P > 0.05). The amount of PCT (0.23 ng/ml vs 1.15 ng/ml) and IL-6 (54.49 pg/ml vs 233.49 pg/ml) decreased post-surgery in Group A compared to Group B, but were not statistically significant difference (P = 0.424/P = 0.502), and more patients in Group A were relieved to grade score of pain relief 4 or above (86.7% vs. 60%, P = 0.001).  Conclusions:  Pre-emptive analgesia treatment using PCIA of hydromorphone hydrochloride combined with flurbiprofen axetil has better analgesic effect than routine analgesic therapy in postoperative care of mid to advanced hepatocellular carcinoma TACE, has good safety, and is worth of further promotion and verifying.

Zhou J, Sun H, Wang Z, et al., 2023, Guidelines for the Diagnosis and Treatment of Primary Liver Cancer (2022 Edition). Liver Cancer, 12(5): 405–444.

Zhou B, Wang J, Yan Z, et al., 2012, Liver Cancer: Effects, Safety, and Cost-Effectiveness of Controlled-Release Oxycodone for Pain Control After TACE. Radiology, 262(3): 14–21.

Benzakoun J, Ronot M, Lagadec M, et al., 2017, Risks Factors for Severe Pain After Selective Liver Transarterial Chemoembolization. Liver Int, 37(4): 583–591.

Huang Z, Luo J, Chen M, et al., 2011, Blood Neutrophil-to-Lymphocyte Ratio Predicts Survival in Patients with Unresectable Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization. J Vasc Interv Radiol, 22(5): 702–9.

Interventional Perioperative Committee, Interventional Physician Branch of Chinese Medical Doctor Association; Interventional Clinical Diagnosis and Treatment Guidelines Committee, et al., 2022, Expert Consensus on the Interventional Perioperative Pain Management for Patients with Liver Malignancy. J Intervent Radiol, 31(10): 943–948.

Jeleazcov C, Ihmsen H, Saari T, et al., 2016, Patient-Controlled Analgesia with Target-Controlled Infusion of Hydromorphone in Postoperative Pain Therapy. Anesthesiology, 124(1): 56–58.

Xiao J, Wang Z, 2022, Analgesic Effect of Combines Use of Parecoxib Sodium and Hydromorphone Hydrochloride during Perioperative TACE in Patients with Advanced Liver Cancer. Shandong Medical Journal, 62(24): 49–52.

Eriksen J, Sagi S, Smith T, et al., 2003, NSAIDs and Enantiomers of Flurbiprofen Target Gamma-Secretase and Lower Abeta 42 in vivo. J Clin Invest, 112(3): 440–9.

Sun P, Zhang M, Zhang Y, 2024, Value of Contrast-Enhanced Ultrasound in Diagnosis of Primary Liver Cancer and Value of Contrast-Enhanced Ultrasound in Diagnosis of Primary Liver Cancer and the Relationship between Imaging Features and Microvascular Typing. Oncology Progress, 22(2): 203–205.

Blackburn H, West S, 2016, Management of Postembolization Syndrome Following Hepatic Transarterial Chemoembolization for Primary or Metastatic Liver Cancer. Cancer Nursing, 39(5): E1–E18.

Li Y, He R, Li Y, 2018, Comprehensive Nursing of Hepatocellular Carcinoma Patients After TACE. Chinese Journal of Interventional Imaging and Therapy, 15(4): 226–229.

Rao Y, Zhao L, Wang R, et al., 2017, Multimodal Analgesia in Patients with Hepatocellular Carcinoma who underwent Transarterial Chemoembolization. Chinese Journal of Hepatobiliary Surgery, 23(6): 375–379.

Wan C, Meng Q, Wang Y, et al., 2020, Patient-Controlled Subcutaneous Analgesia using Sufentainil or Morphine in Home Care Treatment in Patients with Stage III-IV Cancer: A Multi-Center Randomized Controlled Clinical Trial. Cancer Med, 9(15): 5345–5352.

Tian C, Yuan Y, Gao R, et al., 2013, Effects of Different Timing of Dexmedetomidine Administration on Recovery from General Anaesthesia in Gynaecological Laparoscopic Surgery. Practical Drugs and Clinical Medicine, 16(10); 911–912.

Yang F, Wang Jue, Zheng H, et al., 2013, Clinical Observation on the Efficacy and Safety of Dexmedetomidine for Postoperative Analgesia in Thyroid Surgery. Practical Drugs and Clinical Medicine, 16(10): 913–914.

Gu Z, Gao H, Qin G, et al., 2013, Application of Dexmedetomidine Combined with Propofol in Painless Abortion. Practical Drugs and Clinical Medicine, 16(1): 77–78.

Xu Q, Fan X, Gao L, 2012, Clinical Observation of Desmopressin Combined with Levobupivacaine for Cervical Plexus Anaesthesia in Thyroid Surgery. Practical Drugs and Clinical Medicine, 15(11): 718–719.

Maund E, McDaid C, Rise S, et al., 2011, Paracetamol and Selective and Non-Selective Non-Steroidal Anti-Inflammatory Drugs for the Reduction in Morphine-Related Side-Effects After Major Surgery: A Systematic Review. Br J Anaesth, 106(3): 292–7.

Kehlet H, Jensen T, Woolf C, 2006, Persistent Postsurgical Pain: Risk Factors and Prevention. Lancet, 367(9522): 1618–25.

Yang P, Ke W, Wang J, et al., 2014, Comparative Study on the Postoperative Analgesic Effects of Dezocine and Flurbiprofen Esters in Esophageal Cancer Patients Using a Multimodal Analgesic Approach. Chinese Medicine, 9(11): 1638–1642.

Song Y, He Q, Huang W, et al., 2022, New Insight Into the Analgesic Recipe: A Cohort Study Based on Smart Patient-Controlled Analgesia Pumps Records. Front Pharmacol, 2022(13): 988070.

Guo J, Zhao L, Rao Y, et al., 2018, Novel Multimodal Analgesia Regimen Improves Post-TACE Pain in Patients with Hepatocellular Carcinoma. Hepatobiliary Pancreat Dis Int, 17(6): 510–516.

Matsuda M, Huh Y, Ji R, 2019, Roles of Inflammation, Neurogenic Inflammation, and Neuroinflammation in Pain. J Anesth, 33(1): 131–139.

Kelly D, Ahmad M, Brull S, 2001, Pre-emptive Analgesia I: Physiological Pathways and Pharmacological Modalities. Can J Anaesth, 48(10): 1000–10.