Morphine prophylaxis alleviates pain in transjugular intrahepatic portosystemic shunt procedure: A randomized clinical trial

Article type: Research Article

Authors: Li, Ling^{a; b} | Mkangala, Abdala^{a; b} | Geng, Zhiqi^{a; b} | Fan, Wenliang^{a; b} | Ren, Yanqiao^{a; b} | Wang, Zhongmin^c | Zheng, Chuansheng^{a; b} | Xiao, Shuping^{a; b; *}

Affiliations: [a] Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China | [b] Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China | [c] Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

Correspondence: [*] Corresponding author: Shuping Xiao, Department of Radiology, Union hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei 430022, China. E-mail: shupingx45@163.com.

Abstract: BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) is an accepted minimal invasive procedure for the management of complications of portal hypertension. OBJECTIVE: This study aims to investigate the value of the preemptive administration of morphine, when compared with on-demand morphine, during TIPS. METHODS: The present study was a randomized control trial. A total of 49 patients were selected to receive 10 mg of morphine either before the TIPS procedure (group B, n= 26), or on demand when needed during the TIPS procedure (group A, n= 23). The patient’s pain was scored using the visual analog scale (VAS) during the procedure. VAS, pain performance, HR, systolic pressure, diastolic pressure and SPO2 were recorded at four-time points: before the operation (T0), during the trans-hepatic puncture of the portal vein (T1), during the intrahepatic channel expansion (T2), and when the operation was finished (T3). The duration of the operation was also recorded. RESULTS: In group A, the proportion of severe pain at T1 was 4.3% (one case), two cases were combined with vagus reflex, and the proportion of severe pain at T2 was 65.2% (15 cases). No severe pain occurred in group B. The VAS score significantly decreased at T1, T2 and T3 in group B, when compared to group A (P< 0.05). HR, systolic pressure and diastolic pressure significantly decreased at T2 and T3 in group B, when compared to group A (P< 0.05). There was no significant difference between the two groups in terms of SPO2 (P> 0.05). CONCLUSION: Preemptive analgesia can effectively relieve severe pain during TIPS, improve patient comfort and compliance, ensure a routine procedure, and offer excellent safety, and is simple and effective.

Keywords: Preemptive analgesia, morphine, TIPS, pain, visual analogue scale

DOI: 10.3233/THC-220572

Journal: Technology and Health Care, vol. 31, no. 4, pp. 1293-1300, 2023