Hepatic artery embolization: Factors predisposing to postembolization painand nausea

PURPOSE: Analysis of preprocedural factors that may be helpful in predictin g the severity of pain and nausea after hepatic arterial embolization (HAE) for liver neoplasms. MATERIALS AND METHODS: During a a-year period, 62 patients (33 men, 29 wome n) underwent 130 palliative lobar HAEs for unresectable liver neoplasms, Th e hepatic lobe was embolized with 150-250-mu m polyvinyl alcohol particulat es with or without lipiodol and/or chemotherapeutic agents, Postembolizatio n pain was rated at rest and during movement with use of an Ii-point verbal pain scale, and postembolization nausea was assessed with use of a four-po int verbal scale, each at two separate time periods. Daily morphine use was also recorded. Primary analysis was made using the first embolization proc edure. One-way analysis of variance and Spearman correlation coefficients w ere used to identify associated predictors. Plots of the outcomes versus th e pre-embolization liver function tests and sensitivities and specificities were used to identify the strength of the associations for prediction purp oses. A secondary analysis was performed in patients who underwent multiple embolizations. RESULTS: No strong categorical predictors were found from the ANOVA on the severity of postembolization pain or nausea. There were significant (P < .0 5) associations between the pre-embolization liver function tests and the p ain outcomes only. However, while these laboratory values demonstrate stron g associations with resultant pain, they are not strong predictors of pain and morphine requirements for any individual patient. The morphine requirem ents were highly associated (P < .0001) with the pain scores at rest and wi th movement. The authors did not find significant differences on any of the pain outcomes or morphine requirements between the first and second emboli zations. CONCLUSION: Laboratory values and patient age are not predictors for the se verity of postembolization pain and nausea. Postembolization pain is a sign ificant complication and poses a continuing challenge to the physician with regards to patient management.