Effectiveness and safety of multimodal analgesic management based on the ERAS concept in the perioperative period of TACE for patients with Intermediate and advanced hepatocellular carcinoma.

Abstract

12085 Background: To evaluate the effectiveness and safety of multimodal analgesic management based on the enhanced recovery after surgery (ERAS) concept in the perioperative period of transarterial chemoembolization (TACE) for patients with advanced hepatocellular carcinoma. Methods: A retrospective analysis was conducted on 90 patients who underwent TACE at the First Affiliated Hospital of Sun Yat-sen University from January 2022 to October 2023. Patients were divided into two groups: Group A received a multimodal analgesic regimen based on the ERAS concept, which included preoperative administration of 6 mg hydromorphone hydrochloride and 50 mg flurbiprofen axetil, diluted in normal saline to a total of 100 ml and infused via a patient-controlled intravenous analgesia (PCIA) pump. Group B received conventional perioperative management combined with traditional analgesic methods, using intravenous flurbiprofen axetil 50 mg or intramuscular tramadol 100 mg for postoperative pain. Pain levels were recorded using the Numeric Rating Scale (NRS) at various time points: intraoperatively, immediately postoperatively, and at 1, 6, 12, and 24 hours post-surgery, along with the incidence of adverse reactions within 24 hours. Inflammatory indicators were compared before and after TACE, and patient satisfaction and cost-effectiveness analyses were conducted. Results: The NRS scores for Group A at the five time points were 3.0 (3.0–2.0), 3.0 (4.0–2.0), 4.0 (5.0–3.0), 3.0 (3.5–2.0), and 1.0 (1.0–0.5), respectively. For Group B, the scores were 4.0 (5.0–3.0), 4.0 (5.0–3.0), 5.0 (6.0–3.5), 3.0 (4.0–2.0), and 1.0 (2.0–1.0) , respectively. Except for the NRS score at 12 hours post-surgery, all other time points showed statistically significant differences. There was no statistically significant difference in the levels of PCT and IL-6 before and after surgery between the two groups, but a trend of lower postoperative PCT and IL-6 levels in Group A compared to Group B was observed. The incidence of various adverse reactions 24 hours post-surgery did not differ significantly between the two groups (P > 0.05). Patient satisfaction with analgesia at 48 hours post-surgery was significantly higher in Group A than in Group B, with a statistically significant difference (P = 0.001). Group A demonstrated better economic benefits. Conclusions: The results of this study indicate that multimodal analgesic management based on the ERAS concept has better analgesic effects during the perioperative period of TACE treatment, with comparable safety and improved economic benefits. This provides strong support for the clinical application of multimodal analgesic management based on the ERAS concept in TACE for liver cancer.