The Effectiveness and Safety of Multimodal Pre-Emptive Analgesia in the Perioperative Period of Mid to Advanced Hepatocellular Carcinoma Undergoing TACE

Chunhong Li, Nan Zhang, Yanqin Wu, Xiaoping Yu, Shanshan Deng, Qingmiao Liu, Jiaping Li

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¹ Department of Inverventional Oncology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, Guangdong, China,

² Department of Inverventional Oncology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, Guangdong, China; Nursing Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, Guangdong, China,

JCNR 2025 , 9(10), 157–167; https://doi.org/10.26689/jcnr.v9i10.12535

© 2025 by the Authors. Licensee Whioce Publishing, Singapore. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )

Abstract

Objective: 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.

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