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Radiofrequency Ablation of Peripheral Liver Tumors: Intraperitoneal 5% Dextrose in Water Decreases Postprocedural Pain

J. Louis Hinshaw1, Paul F. Laeseke1, Thomas C. Winter, III1, Mark A. Kliewer1, Jason P. Fine1 and Fred T. Lee, Jr.1

1 All authors: Department of Radiology, University of Wisconsin, E3/311 CSC, 600 Highland Ave., Madison, WI 53792.


Figure 1
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  		Fig. 1 —63-year-old woman with hepatic colon cancer metastasis. Contrast-enhanced CT image shows ablation zone in periphery of right lobe of liver. Length and width of ablation zone and involvement of liver capsule (asterisk) were measured on CT scan obtained immediately after ablation. Fluid layer adjacent to liver represents instilled 5% dextrose in water (arrowhead).

 

Figure 2
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  		Fig. 2 —Setup used for infusion of 5% dextrose in water (D5W). IV bag containing D5W is attached to three-way stopcock. Low-pressure tubing is then used to connect stopcock to 20-gauge spinal needle that is introduced into peritoneum. This setup allows for infusion of D5W through a closed, sterile system.

 

Figure 3
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  		Fig. 3 —63-year-old woman with hepatic colon cancer metastasis. Transverse sonogram was obtained during radiofrequency ablation of peripheral tumor in right lobe of liver. Ablation zone is indicated by hyperechoic region with dirty posterior shadowing (asterisk) that represents gas bubbles. Anechoic fluid layer between liver and adjacent abdominal wall (arrow) represents instilled 5% dextrose in water.

 

Figure 4
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  		Fig. 4A —Pain level and analgesia use graphed over time. Self-reported pain level was higher at all time points for patients not receiving 5% dextrose in water (D5W), with absolute pain decreasing over time in both groups. This difference was statistically significant during first 8 hr after procedure. * = p < 0.05, {diamondsuit} = no D5W, {blacksquare} = D5W.

 

Figure 5
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  		Fig. 4B —Pain level and analgesia use graphed over time. Patient-controlled analgesia use was substantially higher for patients not receiving D5W, with overall usage and difference between groups decreasing over time. This difference was statistically significant during first 16 hr after procedure. * = p < 0.05, {diamondsuit} = no D5W, {blacksquare} = D5W.

 

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