Impact of fentanyl analgesia on the accuracy of HVPG measurements in patients with cirrhosis: a prospective, multicenter study

Author:

Zhang Haijun1,Yang Lili2,Yu Ziniu3,Li Dan4,Li Lei5,Li Shuangxi5,Yan Jun67,Li Xun1678

Affiliation:

1. Department of Anesthesiology and Operating Theater, The First Hospital of Lanzhou University, Lanzhou, China

2. Department of Anesthesiology, Lishui Central Hospital, Lishui, China

3. Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Interventional Treatment Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

4. Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China

5. Interventional Radiology Department, The First Hospital of Lanzhou University, Lanzhou, China

6. The Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China

7. Key Laboratory of Biotherapy and Regenerative Medicine of Gansu Province, Lanzhou, China

8. The First School of Clinical Medicine, Lanzhou University, Lanzhou, China

Abstract

Background: HVPG measurement is the gold standard for assessing portal hypertension. Many patients decline HVPG measurements due to associated pain. According to previous studies, propofol sedation during HVPG measurements potentially alters HVPG readings. However, opioid analgesics’ effects on HVPG await full elucidation. This study aimed to evaluate fentanyl analgesia’s effects on HVPG measurement accuracy in patients with cirrhosis. Methods: This prospective, multicenter study included patients with cirrhosis undergoing HVPG measurements, which were performed preanalgesia and under analgesia with fentanyl injection (1.0 or 1.5 μg/kg). Results: Of the 48 enrolled patients with cirrhosis, 23 were administered 1.0 μg/kg fentanyl analgesia during HVPG measurement. The HVPG was 13.4±4.9 mm Hg in preanalgesia and 13.5±5.2 mm Hg under analgesia. HVPG measurement accuracy was not altered after fentanyl analgesia (p = 0.801). The following measures also did not change: heart rate (p = 0.132), mean arterial pressure (p = 0.348), and blood oxygen saturation (p = 0.748); however, respiratory rate (p = 0.001) changes occurred. The Verbal Numerical Rating Score for comfort under analgesia was higher than that in preanalgesia (p = 0.001). Twenty-five patients were administered 1.5 μg/kg fentanyl analgesia during HVPG measurement. The HVPG was 19.5±5.7 mm Hg in preanalgesia and 19.6±5.6 mm Hg under analgesia. HVPG measurement accuracy did not alter after fentanyl analgesia (p = 0.469). Similarly, the following measures did not change: mean arterial pressure (p = 0.871) and oxygen saturation (p = 0.327); nevertheless, respiratory rate (p = 0.015) and heart rate (p = 0.019) changes occurred. The Verbal Numerical Rating Score for comfort under analgesia was higher than that in preanalgesia (p < 0.001). Conclusion: Fentanyl analgesia did not alter HVPG measurement accuracy, and fentanyl improved comfort in patients with cirrhosis during HVPG measurements.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Hepatology

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