Zonia Ghumman, Presenter: Research support, Toshiba Corporation

Hassan Shoushtari MD, Abstract Co-Author: Nothing to Disclose

Ravi Menezes PhD, Abstract Co-Author: Nothing to Disclose

Demetris Andrea Patsios MBBCh, Abstract Co-Author: Nothing to Disclose

Yasser Karimzad BSc, Abstract Co-Author: Nothing to Disclose

Narinder S. Paul MD, Abstract Co-Author: Research funded, Toshiba Corporation

To identify patients at increased risk for pain related to CT guided fine needle aspiration biopsy (CT-FNAB) of the lung.

IRB approved prospective recruitment of patients referred for CT-FNAB from February–May 2013. Patients completed 3 questionnaires: 30 minutes prior to CT-FNAB (Q1), 30 minutes post CT-FNAB (Q2) and ≤72 hours post CT-FNAB (Q3). The validated Brief Pain Inventory (BPI) was included to assess how pain interfered in the patients’ daily activities and was rated based on pain severity (PS) and pain interference (PI). The BPI used numerical rating scales from 0 (no pain/interference) to 10 (severe pain/interference). The radiologist documented use of IV analgesia (fentanyl 50-100mcg) and sedation (midazolam 1-2mg) during CT-FNAB (Q4).

The study cohort included 50 patients (29 males, 21 females), with a mean age of 65.2 years ([40, 83], SD 9.5). BPI scores [mean (range)] showed PS and PI scores pre-procedure = 1.14 (0-6.8) and 0.93 (0-7.3), and 48-72 hours post-procedure = 1.05 (0-6.3) and 0.58 (0-6.7) respectively. Most patients had low mean PS and PI scores pre- and post-procedure. A subset of 9/50 patients (18%) had chronic discomfort from pre-existing conditions and scored the highest in both domains. Mean PS and PI domains pre-procedure for this population were 3.69 (1.5-6.8) and 3.78 (0-7.3), while mean PS and PI domains post-procedure were 3.33 (0-6.3) and 2.14 (0-6.7). Patients in the prone position (36/50, 72%) experienced significantly more discomfort than patients in the supine position (p=0.013, Mann-Whitney test). Additional IV analgesia and sedation was only required in 5 patients (10%) all of whom were prone during CT-FNAB.

Patients with pre-existing painful conditions and those who require prone positioning during CT-FNAB are at higher risk for procedure related pain. Patients with co-morbid painful conditions can be identified pre-procedure using a short, validated pain score and provided with individualized pain management. Patients that need to be prone during CT-FNAB can be positioned strategically with extra cushioning and given increased analgesia for improved pain management.

Pain is a side effect of CT-FNAB that can be minimized if modifiable risk factors like patient positioning and analgesic control are identified correctly and adjusted accordingly.

Ghumman, Z, Shoushtari, H, Menezes, R, Patsios, D, Karimzad, Y, Paul, N, Pain Perception in Patients Undergoing CT Guided Lung Biopsies.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045503.html