Abstract
Background
Although pain is a common complication of endoscopic submucosal dissection (ESD), management strategies are inadequate. The aim of this study was to evaluate the efficacy of topical bupivacaine and triamcinolone acetonide for abdominal pain relief and as a potential method of pain control after ESD for gastric neoplasia.
Methods
In this randomized, double-blind, placebo-controlled trial, 111 eligible patients with early gastric neoplasm were randomized into one of three groups: bupivacaine (BV) only, bupivacaine with triamcinolone (BV-TA), or placebo. The present pain intensity (PPI) score and the Short-Form McGill Pain Questionnaire (SF-MPQ) were used to evaluate pain at 0, 6, 12, and 24 h after ESD.
Results
The mean values for the 6-hour PPI in the BV-TA and BV groups were lower than those of the placebo group (1.57 ± 1.09 and 1.97 ± 1.09 vs. 2.63 ± 0.98, p < 0.001). The 12-hour PPI of the BV-TA group (1.20 ± 0.83) was the lowest among the three groups (p = 0.001). The total 6-hour SF-MPQ score, especially in the sensory domain, was higher in the placebo group than in BV and BV-TA groups. The 12-hour SF-MPQ score was the lowest in the BV-TA group. Multivariate analysis demonstrated that BV-TA injection protocol, fibrosis, and size of residual ulcer were independently associated with the PPI score at 6 h.
Conclusion
Bupivacaine after ESD was effective for pain relief at 6 h postoperatively. Particularly, topical infiltration of bupivacaine mixed with triamcinolone acetonide was helpful for producing a more long-lasting benefit of pain relief after gastric ESD.
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References
Park YM, Cho E, Kang HY, Kim JM (2011) The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: a systematic review and metaanalysis. Surg Endosc 25(8):2666–2677
Yamamoto H (2012) Endoscopic submucosal dissection—current success and future directions. Nat Rev Gastroenterol Hepatol 9(9):519–529
Probst A, Pommer B, Golger D, Anthuber M, Arnholdt H, Messmann H (2010) Endoscopic submucosal dissection in gastric neoplasia—experience from a European center. Endoscopy 42(12):1037–1044
Lee H, Cheoi KS, Chung H, Park JC, Shin SK, Lee SK, Lee YC (2012) Clinical features and predictive factors of coagulation syndrome after endoscopic submucosal dissection for early gastric neoplasm. Gastric Cancer 15(1):83–90
Cha JM, Lim KS, Lee SH, Joo YE, Hong SP, Kim TI, Kim HG, Park DI, Kim SE, Yang DH, Shin JE (2013) Clinical outcomes and risk factors of post-polypectomy coagulation syndrome: a multicenter, retrospective, case-control study. Endoscopy 45(3):202–207
Onogi F, Araki H, Ibuka T, Manabe Y, Yamazaki K, Nishiwaki S, Moriwaki H (2010) “Transmural air leak”: a computed tomographic finding following endoscopic submucosal dissection of gastric tumors. Endoscopy 42(6):441–447
Turk DC (2002) Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. Clin J Pain 18(6):355–365
Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R (2003) Lost productive time and cost due to common pain conditions in the US workforce. JAMA 290(18):2443–2454
Kiriyama S, Oda I, Nishimoto F, Mashimo Y, Ikehara H, Gotoda T (2009) Pilot study to assess the safety of local lidocaine injections during endoscopic submucosal dissection for early gastric cancer. Gastric Cancer 12(3):142–147
Choi HS, Kim KO, Chun HJ, Keum B, Seo YS, Kim YS, Jeen YT, Um SH, Lee HS, Kim CD, Ryu HS (2012) The efficacy of transdermal fentanyl for pain relief after endoscopic submucosal dissection: a prospective, randomised controlled trial. Dig Liver Dis 44(11):925–929
Kahokehr A, Sammour T, Srinivasa S, Hill AG (2011) Systematic review and meta-analysis of intraperitoneal local anaesthetic for pain reduction after laparoscopic gastric procedures. Br J Surg 98(1):29–36
Santosh D, Lakhtakia S, Gupta R, Reddy DN, Rao GV, Tandan M, Ramchandani M, Guda NM (2009) Clinical trial: a randomized trial comparing fluoroscopy guided percutaneous technique vs. endoscopic ultrasound guided technique of coeliac plexus block for treatment of pain in chronic pancreatitis. Aliment Pharmacol Ther 29(9):979–984
Stevens T, Costanzo A, Lopez R, Kapural L, Parsi MA, Vargo JJ (2012) Adding triamcinolone to endoscopic ultrasound-guided celiac plexus blockade does not reduce pain in patients with chronic pancreatitis. Clin Gastroenterol Hepatol 10(2):186–191 191 e181
Levy MJ, Topazian MD, Wiersema MJ, Clain JE, Rajan E, Wang KK, de la Mora JG, Gleeson FC, Pearson RK, Pelaez MC, Petersen BT, Vege SS, Chari ST (2008) Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct Ganglia neurolysis and block. Am J Gastroenterol 103(1):98–103
Ganta R, Samra SK, Maddineni VR, Furness G (1994) Comparison of the effectiveness of bilateral ilioinguinal nerve block and wound infiltration for postoperative analgesia after caesarean section. Br J Anaesth 72(2):229–230
Feroci F, Kroning KC, Scatizzi M (2009) Effectiveness for pain after laparoscopic cholecystectomy of 0.5 % bupivacaine-soaked Tabotamp placed in the gallbladder bed: a prospective, randomized, clinical trial. Surg Endosc 23(10):2214–2220
Roberts KJ, Gilmour J, Pande R, Nightingale P, Tan LC, Khan S (2011) Efficacy of intraperitoneal local anaesthetic techniques during laparoscopic cholecystectomy. Surg Endosc 25(11):3698–3705
Wright KD, Asmundson GJ, McCreary DR (2001) Factorial validity of the short-form McGill pain questionnaire (SF-MPQ). Eur J Pain 5(3):279–284
Hanaoka N, Ishihara R, Takeuchi Y, Uedo N, Higashino K, Ohta T, Kanzaki H, Hanafusa M, Nagai K, Matsui F, Iishi H, Tatsuta M, Ito Y (2012) Intralesional steroid injection to prevent stricture after endoscopic submucosal dissection for esophageal cancer: a controlled prospective study. Endoscopy 44(11):1007–1011
Hashimoto S, Kobayashi M, Takeuchi M, Sato Y, Narisawa R, Aoyagi Y (2011) The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection. Gastrointest Endosc 74(6):1389–1393
Lee BS, Kim SM, Seong JK, Kim SH, Jeong HY, Lee HY, Song KS, Kang DY, Noh SM, Shin KS, Cho JS (2005) Phlegmonous gastritis after endoscopic mucosal resection. Endoscopy 37(5):490–493
Probst A, Maerkl B, Bittinger M, Messmann H (2010) Gastric ischemia following endoscopic submucosal dissection of early gastric cancer. Gastric Cancer 13(1):58–61
Nicholson G, Hall GM (2011) Effects of anaesthesia on the inflammatory response to injury. Curr Opin Anaesthesiol 24(4):370–374
Wong GY, Schroeder DR, Carns PE, Wilson JL, Martin DP, Kinney MO, Mantilla CB, Warner DO (2004) Effect of neurolytic celiac plexus block on pain relief, quality of life, and survival in patients with unresectable pancreatic cancer: a randomized controlled trial. JAMA 291(9):1092–1099
Boddy AP, Mehta S, Rhodes M (2006) The effect of intraperitoneal local anesthesia in laparoscopic cholecystectomy: a systematic review and meta-analysis. Anesth Analg 103(3):682–688
Covino BG (1986) Pharmacology of local anaesthetic agents. Br J Anaesth 58(7):701–716
Concepcion M, Covino BG (1984) Rational use of local anaesthetics. Drugs 27(3):256–270
Galligan JJ (2004) Enteric P2X receptors as potential targets for drug treatment of the irritable bowel syndrome. Br J Pharmacol 141(8):1294–1302
Castillo J, Curley J, Hotz J, Uezono M, Tigner J, Chasin M, Wilder R, Langer R, Berde C (1996) Glucocorticoids prolong rat sciatic nerve blockade in vivo from bupivacaine microspheres. Anesthesiology 85(5):1157–1166
Mori H, Rafiq K, Kobara H, Fujihara S, Nishiyama N, Kobayashi M, Himoto T, Haba R, Hagiike M, Izuishi K, Okano K, Suzuki Y, Masaki T (2012) Local steroid injection into the artificial ulcer created by endoscopic submucosal dissection for gastric cancer: prevention of gastric deformity. Endoscopy 44(7):641–648
Fujiwara S, Morita Y, Toyonaga T, Kawakami F, Itoh T, Yoshida M, Kutsumi H, Azuma T (2011) A randomized controlled trial of rebamipide plus rabeprazole for the healing of artificial ulcers after endoscopic submucosal dissection. J Gastroenterol 46(5):595–602
Mori H, Fujihara S, Nishiyama N, Kobara H, Oryu M, Kato K, Rafiq K, Masaki T (2013) Cytomegalovirus-associated gastric ulcer: a side effect of steroid injections for pyloric stenosis. World J Gastroenterol 19(7):1143–1146
Disclosures
Drs. B.Kim, H.S.Chung, J.C.Park, S.K.Shin, S.K.Lee, Y.C.Lee, and H.Lee have no conflicts of interest or financial ties to disclose.
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This study was registered on clinicaltrials.gov under identifier NCT01961752.
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Kim, B., Lee, H., Chung, H. et al. The efficacy of topical bupivacaine and triamcinolone acetonide injection in the relief of pain after endoscopic submucosal dissection for gastric neoplasia: a randomized double-blind, placebo-controlled trial. Surg Endosc 29, 714–722 (2015). https://doi.org/10.1007/s00464-014-3730-4
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DOI: https://doi.org/10.1007/s00464-014-3730-4