Introduction: Liver biopsy remains the gold standard for the diagnosis and staging of liver diseases. Despite being painful, analgesia before liver biopsy is usually avoided due to the notion that pain is minor and due to the concern of masking possible abdominal symptoms. Postbiopsy pain levels were previously mapped for the purpose of analgesia planning.
Aim: To compare pain and anxiety levels between two prophylactic treatment regimens, a combination of sublingual tramadol Hcl with oral lorazepam and oral diazepam only.
Patients and methods: One hundred and thirteen consecutive patients were selected to receive either prophylactic analgesia with sublingual tramadol Hcl (50 mg) flashtabs and oral lorazepam [(1 mg) analgesia group (AG), n=56] or oral diazepam (5 mg) alone [nonAG (NAG), n=57]. Pain and anxiety levels were assessed using Visual Analogue Scale (1-10) and State Anxiety Inventory, respectively, 30 min before, and 30 min and 6 h after the biopsy.
Results: The groups were comparable with respect to baseline characteristics. Thirty minutes after the procedure, pain levels were significantly lower in the AG (mean Visual Analogue Scale ± standard error of the mean, 1.8 ± 0. 3; median=1) compared with the NAG (3.1 ± 0.3, median=3; P<0.005). Patients in the NAG (13.8%), reported high pain intensities (>7) compared with the patients in the AG (3.6%; P=0.09). Six hours after the procedure, pain intensity remained significantly lower in the AG compared with the NAG (0.8 ± 0.1 vs. 1.5 ± 0.2; P<0.005). Anxiety levels were comparable.
Conclusion: Prophylactic combination of short-acting tramadol and lorazepam is effective, safe, and can be used routinely before liver biopsy.